Prone and Lateral Positioning in Spontaneously Breathing Patients With COVID-19 Pneumonia Undergoing Noninvasive Helmet CPAP Treatment

Retucci, Mariangela; Aliberti, Stefano; Ceruti, Clara; Santambrogio, Martina; Tammaro, Serena; Cuccarini, Filippo; Carai, Claudia; Grasselli, Giacomo; Oneta, Anna Maria; Saderi, Laura; Sotgiu, Giovanni; Privitera, Emilia; Blasi, Francesco

doi:10.1016/j.chest.2020.07.006

Cited by 65 publications

(120 citation statements)

References 11 publications

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…From this, 162 articles were selected for full text review and 35 articles met inclusion criteria and were included in the final rapid review synthesis. A total of 35 studies (including 12 prospective cohorts, 18 retrospective cohorts, and 5 case reports) with 414 patients were synthesized (see Table 1 and Table 2 ) [ [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] ]. Twenty-nine of these studies ( n = 364 patients; 11 prospective cohorts, 13 retrospective cohorts, 5 case reports) report on the use of awake prone positioning in COVID-19 patients [ [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [19] , [20] , [21] , [24] , [25] , [26] , [27] , [28] , [29] , [31] , [32] , [33] , [35] , [36] , [37] , [38] , [39] , …”

Section: Resultsmentioning

confidence: 99%

“…Only one study included data from a control group [ 44 ]. Seventeen studies (128 patients) were conducted exclusively within the ICU [ 12 , [16] , [17] , [18] , [19] , 22 , 23 , 25 , [29] , [30] , [31] , 34 , 35 , 37 , [40] , [41] , [42] ], two in the emergency department (60 patients) [ 10 , 13 ], eight exclusively on a non-ICU hospital ward (104 patients) [ 14 , 20 , 21 , 27 , 28 , 32 , 33 , 38 ], and two studies included patients in multiple settings (73 patients) [ 15 , 36 ]. The setting was not reported in 6 studies (49 patients) [ 11 , 24 , 26 , 39 , 43 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Awake prone positioning for COVID-19 hypoxemic respiratory failure: A rapid review

Weatherald

Solverson

Zuege

et al. 2021

Journal of Critical Care

View full text Add to dashboard Cite

Background Infection with SARS-CoV-2 can result in Coronavirus Disease–19 (COVID-19) [1, 2]. While the majority of patients are asymptomatic or have mild disease [3], approximately 14% develop more severe disease including hypoxemic respiratory failure and/or Acute Respiratory Distress Syndrome (ARDS) [3]. Prone positioning is a life-saving intervention for mechanically ventilated patients with moderate-severe ARDS [4]. Based on this, the World Health Organization (WHO) guidelines recommend these patients be considered for a trial of prone positioning [5]. Recently the use of prone positioning in awake non-intubated COVID-19 patients has been recommended by several notable organizations with the goal of preventing intubation and potentially improving patient-oriented outcomes [6, 7]. In contrast to prone positioning for intubated mechanically ventilated patients with ARDS, there have been no randomized control trials examining the role of awake prone positioning for non-intubated patients with hypoxemic respiratory failure. To further explore this question we used rapid review methodology (Tricco et al., 2015 [8]) to quickly identify and synthesize studies examining the effect of awake prone positioning on patients with hypoxemic respiratory failure (including those with ARDS and/or COVID-19). Methods We have elected to use “rapid review” methodology rather than “systematic review” methodology primarily due to the speed and efficiency through which we are able to conduct this review, as previously described [8]. In the absence of an EQUATOR guidance document, we used PRISMA guidelines where applicable [9]. Studies were included if they met the following criteria 1) population – non-intubated patients with hypoxemic respiratory failure, 2) intervention – prone positioning, 3) comparator – usual management, 4) outcomes – intubation, survival, change in respiratory parameters, adverse events, 5) setting – hospitalized patients 6) study design – observational or randomized control trial. Studies were not limited to ARDS or COVID-19 patients. The search strategy was developed by a critical care physician (KP), a critical care epidemiologist (KF) and a medical librarian (NL) (See search details in Online Supplement ). Briefly, the search strategy involved combinations of keywords and subject headings relating to the concepts of, 1) SARS-Cov-2 or COVID-19 or coronavirus, 2) awake prone positioning, and 3) hypoxemic respiratory failure, including but not limited to ARDS and other potentially relevant conditions. The search was conducted on May 19, 2020 and was updated on August 7, 2020 with no restrictions on publication language or date. Databases and grey literature sources searched included: MEDLINE (Ovid), PubMed, Trip PRO, Cochrane Library, Lit...

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Awake prone positioning for COVID-19 hypoxemic respiratory failure: A rapid review

Weatherald

Solverson

Zuege

et al. 2021

Journal of Critical Care

View full text Add to dashboard Cite

show abstract

“…[12,13] Recent reports suggest that helmet CPAP can be effective for COVID-19 treatment, [14][15][16] possibly combined with prone or lateral position. [17][18][19] In a multicenter cohort study Aliberti et al showed that helmet CPAP signi cantly increased PaO2/FiO2 from oxygen administration alone, but that treatment failure was frequent, occurring in 44% of patients who required intubation and invasive ventilation. [20] Early recognition of patients at high risk of treatment failure is crucial, both for individual treatment and resources allocation.…”

Section: Introductionmentioning

confidence: 99%

Helmet CPAP to Treat Hypoxic Pneumonia Outside the ICU: An Observational Study During the COVID-19 Outbreak

Coppadoro

Benini

Fruscio

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may threaten healthcare systems hold, due to the surge patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe hypoxia. Helmet is as effective interface to provide Continuous Positive Airway Pressure (CPAP) non-invasively. We report data about the usefulness of helmet CPAP during pandemic, either as an effective treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI).Methods: In this observational study we collected data regarding patients failing standard oxygen therapy (i.e. non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients’ data were recorded before, at initiation of CPAP treatment and once a day, since. CPAP failure was defined as a composite outcome of intubation or death.Results: A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full-treatment and 29% of the DNI patients (P<0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P<0.001); respiratory rate decreased from 28 [22-32] to 24 [20-29] breaths per minute, P<0.001). CPAP failure was independently associated with CRP, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities. Helmet CPAP was maintained for 6 [3-9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wardsConclusions: Helmet CPAP treatment is feasible for several days outside the ICU, despite persisting hypoxia. It is effective, avoiding intubation in the majority of full treatment patients when standard oxygen therapy fails. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival.Trial Registration: NCT04424992

show abstract

“…Oxygenation outcomes were analysed based on the mean pre-PP PaO 2 /FiO 2 ≤ 150 (5 studies [10,28,29,33,37]) or > 150 (6 studies [2,9,27,30,32,35] 5).…”

Section: Funnel Plots and Egger's Regression Test Formentioning

confidence: 99%

“…FiO 2 , PaO 2 and SpO 2 are presented in Additional Fig. 4.Secondary Outcomes:Intubation after a trial of PP was reported in 14 studies[2,10,[26][27][28][29][30][31][32][33][34][35][36][37]. A total of 90 patients out of 426 (21.1%) were intubated following a trial of PP.…”

mentioning

confidence: 99%

Prone Positioning of Non-intubated Patients with COVID-19 - A Systematic Review and Meta-analysis

Reddy

Subramaniam

Lim

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose: Several studies have reported adopting prone positioning (PP) in non-intubated patients with COVID-19-related hypoxaemic respiratory failure. This systematic review and meta-analysis evaluated the impact of PP on oxygenation and clinical outcomes.Methods: We searched PubMed, Embase and the COVID-19 living systematic review from December 1, 2019 to July 23, 2020. We included studies that reported using PP in hypoxaemic, non-intubated adult patients with COVID-19. Primary outcome measureed was the weighted mean difference (MD) in oxygenation parameters (PaO2/FiO2, PaO2 or SpO2) pre and post-PP. Results: Fifteen single arm observational studies reporting PP in 449 patients were included. Substantial heterogeneity was noted in terms of, location within hospital where PP was instituted, respiratory supports during PP, and frequency and duration of PP. Significant improvement in oxygenation was reported post-PP: PaO2/FiO2 (MD 37.6, 95% CI 18.8-56.5); PaO2 (MD 30.4 mmHg, 95% CI 10.9 to 49.9); and SpO2 (MD 5.8%, 95% CI 3.7 to 7.9). Patients with a pre-PP PaO2/FiO2 ≤150 experienced greater oxygenation improvements compared with those with a pre-PP PaO2/FiO2 >150 (MD 40.5, 95% CI -3.5 to 84.6) vs. 37, 95% CI 17.1 to 56.9). Respiratory rate decreased post-PP (MD -2.9, 95% CI -5.4 to -0.4). Overall intubation and mortality rates were 21% (90/426) and 26% (101/390) respectively. There were no major adverse events reported. Conclusions: Despite the significant variability in frequency and duration of PP and respiratory supports applied, PP was associated with improvements in oxygenation parameters without any reported serious adverse events. The results are limited by lack of control arm and adjustment for confounders. Clinical trials are required to determine the effect of awake PP on patient-centred outcomes.Systematic review registration: Registration/protocol in PROSPERO (CRD42020194080).

show abstract

Prone and Lateral Positioning in Spontaneously Breathing Patients With COVID-19 Pneumonia Undergoing Noninvasive Helmet CPAP Treatment

Cited by 65 publications

References 11 publications

Awake prone positioning for COVID-19 hypoxemic respiratory failure: A rapid review

Awake prone positioning for COVID-19 hypoxemic respiratory failure: A rapid review

Helmet CPAP to Treat Hypoxic Pneumonia Outside the ICU: An Observational Study During the COVID-19 Outbreak

Prone Positioning of Non-intubated Patients with COVID-19 - A Systematic Review and Meta-analysis

Contact Info

Product

Resources

About

Prone and Lateral Positioning in Spontaneously Breathing Patients With COVID-19 Pneumonia Undergoing Noninvasive Helmet CPAP Treatment

Cited by 65 publications

References 11 publications

Awake prone positioning for COVID-19 hypoxemic respiratory failure: A rapid review

Awake prone positioning for COVID-19 hypoxemic respiratory failure: A rapid review

Helmet CPAP&nbsp;to Treat Hypoxic Pneumonia Outside the ICU: An Observational Study During the COVID-19 Outbreak

Prone Positioning of Non-intubated Patients with COVID-19 - A Systematic Review and Meta-analysis

Contact Info

Product

Resources

About

Helmet CPAP to Treat Hypoxic Pneumonia Outside the ICU: An Observational Study During the COVID-19 Outbreak