Prone positioning in COVID-19 acute respiratory failure: just do it?

McNicholas, Bairbre; Cosgrave, David; Giacomini, Camilla; Brennan, Aoife M.; Laffey, John G.

doi:10.1016/j.bja.2020.06.003

Cited by 30 publications

(34 citation statements)

References 36 publications

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“…Another way to improve oxygenation that has been advocated for patients with covid-19 is “awake proning.”21 Proning is an established therapy for refractory T1RF in intubated patients that improves oxygenation by minimising ventilation/perfusion mismatch in the lung 2223. Proning has been widely used in awake patients with covid-19,212425 although high quality evidence regarding its efficacy in awake patients is pending.…”

Section: Management Of Respiratory Failurementioning

confidence: 99%

Respiratory failure and non-invasive respiratory support during the covid-19 pandemic: an update for re-deployed hospital doctors and primary care physicians

Nicholson

Talbot

Nickol

et al. 2020

BMJ

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Section: Management Of Respiratory Failurementioning

confidence: 99%

Respiratory failure and non-invasive respiratory support during the covid-19 pandemic: an update for re-deployed hospital doctors and primary care physicians

Nicholson

Talbot

Nickol

et al. 2020

BMJ

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“…Both guidelines and expert opinion recommend 12–16 h per day of prone positioning for patients with moderate-to-severe ARDS from COVID-19. 1 , 2 Many of the most severely affected survivors from COVID-19 are now being discharged to inpatient rehabilitation hospitals. 3 This provides an important opportunity to assess the long-term sequelae of prone positioning in this patient population.…”

mentioning

confidence: 99%

Injury-prone: peripheral nerve injuries associated with prone positioning for COVID-19-related acute respiratory distress syndrome

Malik

Wolfe

Soriano

et al. 2020

British Journal of Anaesthesia

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“…In addition to oxygen therapy, awake prone positioning can also be used as adjuvant therapy for improving oxygenation in COVID‐19 patients 327,328,330–333 . In the supine position, the pressure in the abdominal compartment exceeds that in the chest; the highest intra‐abdominal pressure is in the dorsal regions of the lung and thus compression of the dorsocaudal regions of the lung occurs.…”

Section: Adjuvant Therapy Of Sars‐cov‐2 Infectionsmentioning

confidence: 99%

“…Moreover, their rate of intubation and mechanical ventilation was no different between those who benefited from prone positioning and those who did not benefit from prone positioning. Thus, questions still remain as to the benefit of prone positioning 332,333 . Additional studies will be required.…”

Section: Adjuvant Therapy Of Sars‐cov‐2 Infectionsmentioning

confidence: 99%

Pathogenesis‐directed therapy of 2019 novel coronavirus disease

Stratton

Tang

2020

Journal of Medical Virology

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The 2019 novel coronavirus disease (COVID‐19) now is considered a global public health emergency. One of the unprecedented challenges is defining the optimal therapy for those patients with severe pneumonia and systemic manifestations of COVID‐19. The optimal therapy should be largely based on the pathogenesis of infections caused by this novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Since the onset of COVID‐19, there have been many prepublications and publications reviewing the therapy of COVID‐19 as well as many prepublications and publications reviewing the pathogenesis of SARS‐CoV‐2. However, there have been no comprehensive reviews that link COVID‐19 therapies to the pathogenic mechanisms of SARS‐CoV‐2. To link COVID‐19 therapies to pathogenic mechanisms of SARS‐CoV‐2, we performed a comprehensive search through MEDLINE, PubMed, medRxiv, EMBASE, Scopus, Google Scholar, and Web of Science using the following keywords: COVID‐19, SARS‐CoV‐2, novel 2019 coronavirus, pathology, pathologic, pathogenesis, pathophysiology, coronavirus pneumonia, coronavirus infection, coronavirus pulmonary infection, coronavirus cardiovascular infection, coronavirus gastroenteritis, coronavirus autopsy findings, viral sepsis, endotheliitis, thrombosis, coagulation abnormalities, immunology, humeral immunity, cellular immunity, inflammation, cytokine storm, superantigen, therapy, treatment, therapeutics, immune‐based therapeutics, antiviral agents, respiratory therapy, oxygen therapy, anticoagulation therapy, adjuvant therapy, and preventative therapy. Opinions expressed in this review also are based on personal experience as clinicians, authors, peer reviewers, and editors. This narrative review linking COVID‐19 therapies with pathogenic mechanisms of SARS‐CoV‐2 has resulted in six major therapeutic goals for COVID‐19 therapy based on the pathogenic mechanisms of SARS‐CoV‐2. These goals are listed below: The first goal is identifying COVID‐19 patients that require both testing and therapy. This is best accomplished with a COVID‐19 molecular test from symptomatic patients as well as determining the oxygen saturation in such patients with a pulse oximeter. Whether a symptomatic respiratory illness is COVID‐19, influenza, or another respiratory pathogen, an oxygen saturation less than 90% means that the patient requires medical assistance. The second goal is to correct the hypoxia. This goal generally requires hospitalization for oxygen therapy; other respiratory‐directed therapies such as prone positioning or mechanical ventilation are often used in the attempt to correct hypoxemia due to COVID‐19. The third goal is to reduce the viral load of SARS‐CoV‐2. Ideally, there would be an oral antiviral agent available such as seen with the use of oseltamivir phosphate for influenza. This oral antiviral agent should be taken early in the course of SARS‐CoV‐2 infection. Such an oral agent is not available yet. Currently, two options are available for reducing the viral load of SARS‐CoV‐2. These are post‐Covid‐1...

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Prone positioning in COVID-19 acute respiratory failure: just do it?

Abstract: Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) in SARS patients: implications for pathogenesis virus transmission pathways. J Pathol 2004; 203: 622e3 30. The human cell atlas.

Cited by 30 publications

References 36 publications

Respiratory failure and non-invasive respiratory support during the covid-19 pandemic: an update for re-deployed hospital doctors and primary care physicians

Respiratory failure and non-invasive respiratory support during the covid-19 pandemic: an update for re-deployed hospital doctors and primary care physicians

Injury-prone: peripheral nerve injuries associated with prone positioning for COVID-19-related acute respiratory distress syndrome

Pathogenesis‐directed therapy of 2019 novel coronavirus disease

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