Efficacy and feasibility of awake proning in patients with COVID-19-related acute hypoxemic respiratory failure: an observational, prospective study

Aisa, Tharwat; Hassan, Tidi; Khan, Ehtesham; Algrni, Khaled; Malik, Muhammed Anwar

doi:10.1007/s11845-022-03009-7

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…Atelectasis, secondary to a lack of surfactant, increased over time. The type 2 alveolar epithelial cells contain receptors for the COVID-19 virus and, when infected, can be destroyed, thus diminishing the surfactant [ 36 ] and ultimately causing basilar-predominant atelectasis, with patient improvement in the prone position [ 37 ]. Figure 4 demonstrates the evolution of lung findings over time, including evidence of epithelial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 on Chest CT: Translating Known Microscopic Findings to Imaging Observations

D’Souza

Capaccione

Soleiman

et al. 2022

Life

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Purpose: To describe the imaging findings of COVID-19 and correlate them with their known pathology observations. Methods: This is an IRB-approved retrospective study performed at Columbia University Irving Medical Center (IRB # AAAS9652) that included symptomatic adult patients (21 years or older) who presented to our emergency room and tested positive for COVID-19 and were either admitted or discharged with at least one chest CT from 11 March 2020 through 1 July 2020. CT scans were ordered by the physicians caring for the patients; our COVID-19 care protocols did not specify the timing for chest CT scans. A scoring system was used to document the extent of pulmonary involvement. The total CT grade was the sum of the individual lobar grades and ranged from 0 (no involvement) to 16 (maximum involvement). The distribution of lung abnormalities was described as peripheral (involving the outer one-third of the lung), central (inner two-thirds of the lung), or both. Additional CT findings, including the presence of pleural fluid, atelectasis, fibrosis, cysts, and pneumothorax, were recorded. Contrast-enhanced CT scans were evaluated for the presence of a pulmonary embolism, while non-contrast chest CT scans were evaluated for hyperdense vessels. Results: 209 patients with 232 CT scans met the inclusion criteria. The average age was 61 years (range 23–97 years), and 56% of the patients were male. The average score reflecting the extent of the disease on the CT was 10.2 (out of a potential grade of 16). Further, 73% of the patients received contrast, which allowed the identification of a pulmonary embolism in 21%. Of those without contrast, 33% had hyperdense vessels, which might suggest a chronic pulmonary embolism. Further, 47% had peripheral opacities and 9% had a Hampton’s hump, and 78% of the patients had central consolidation, while 28% had round consolidations. Atelectasis was, overall, infrequent at 5%. Fibrosis was observed in 11% of those studied, with 6% having cysts and 3% pneumothorax. Conclusions: The CT manifestations of COVID-19 can be divided into findings related to endothelial and epithelial injury, as were seen on prior post-mortem reports. Endothelial injury may benefit from treatments to stabilize the endothelium. Epithelial injury is more prone to developing pulmonary fibrotic changes.

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Section: Discussionmentioning

confidence: 99%

“…Central consolidations were, however, associated with fibrosis. The lack of alveolar epithelial cells with resultant atelectasis predisposes a patient to collapse induration with collagen deposition and irreversible fibrosis [ 37 ]. Therefore, the prevention of atelectasis may have important benefits in the prevention of fibrosis.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 on Chest CT: Translating Known Microscopic Findings to Imaging Observations

D’Souza

Capaccione

Soleiman

et al. 2022

Life

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“…Aisa et al (50) Ireland UC, PCS n = 50 patients 7 patients were intubated (14%). CPP was feasible in 41 (82%) patients, and 38 (76%) patients reported good tolerance Althunayyan et al (51) Saudi Arabia UC, PCS n = 49 patients.…”

Section: Author Country/study Participants Outcomesmentioning

confidence: 99%

Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis

Vásquez-Tirado,

Meregildo-Rodríguez,

Asmat-Rubio

et al. 2024

Crit. Care Sci.

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Objective: To systematically review the effect of the prone position on endotracheal intubation and mortality in nonintubated COVID-19 patients with acute respiratory distress syndrome. Methods: We registered the protocol (CRD42021286711) and searched for four databases and gray literature from inception to December 31, 2022. We included observational studies and clinical trials. There was no limit by date or the language of publication. We excluded case reports, case series, studies not available in full text, and those studies that included children < 18-years-old. Results: We included ten observational studies, eight clinical trials, 3,969 patients, 1,120 endotracheal intubation events, and 843 deaths. All of the studies had a low risk of bias (Newcastle-Ottawa Scale and Risk of Bias 2 tools). We found that the conscious prone position decreased the odds of endotracheal intubation by 44% (OR 0.56; 95%CI 0.40 - 0.78) and mortality by 43% (OR 0.57; 95%CI 0.39 - 0.84) in nonintubated COVID-19 patients with acute respiratory distress syndrome. This protective effect on endotracheal intubation and mortality was more robust in those who spent > 8 hours/day in the conscious prone position (OR 0.43; 95%CI 0.26 - 0.72 and OR 0.38; 95%CI 0.24 - 0.60, respectively). The certainty of the evidence according to the GRADE criteria was moderate. Conclusion: The conscious prone position decreased the odds of endotracheal intubation and mortality, especially when patients spent over 8 hours/day in the conscious prone position and treatment in the intensive care unit. However, our results should be cautiously interpreted due to limitations in evaluating randomized clinical trials, nonrandomized clinical trials and observational studies. However, despite systematic reviews with meta-analyses of randomized clinical trials, we must keep in mind that these studies remain heterogeneous from a clinical and methodological point of view.

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“…The study by Asia et al [ 1 ] on the effect of awake prone positioning on oxygenation in acutely hypoxemic patients requiring respiratory support by non-invasive ventilation (NIV) or high-flow nasal cannula (HFNC) is a timely addition to the medical literature. We would welcome the authors views on several details.…”

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confidence: 99%

Efficacy and feasibility of awake proning in COVID-19: are we missing the other side of the same coin?

et al. 2022

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Efficacy and feasibility of awake proning in patients with COVID-19-related acute hypoxemic respiratory failure: an observational, prospective study

Cited by 6 publications

References 15 publications

COVID-19 on Chest CT: Translating Known Microscopic Findings to Imaging Observations

COVID-19 on Chest CT: Translating Known Microscopic Findings to Imaging Observations

Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis

Efficacy and feasibility of awake proning in COVID-19: are we missing the other side of the same coin?

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