Prone positioning in mechanically ventilated patients with severe acute respiratory distress syndrome and coronavirus disease 2019

Gleissman, Helena; Forsgren, Anders; Andersson, Elisabet; Lindqvist, Elisabet; Falck, Adam Lipka; Cronhjort, Maria; Dahlberg, Martin; Günther, Mattias

doi:10.1111/aas.13741

Cited by 37 publications

(34 citation statements)

References 14 publications

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“…Prone positioning has proven benefits for patients who have non-COVID-19-associated acute respiratory distress syndrome requiring invasive mechanical ventilation (14). Studies have noted increases in use of prone positioning as treatment for critical care patients who have influenza (15) and, in recent months, data have emerged suggesting benefits of prone positioning for ventilated patients (16)(17)(18)(19)(20) and nonventilated patients who have COVID-19 (21). Although potential adverse effects, such as pressure ulcers (22) and deep venous thromboses (23), have been observed with prone positioning, we did not find any statistical association with our primary outcomes.…”

Section: Discussionmentioning

confidence: 99%

Bloodstream Infection Risk, Incidence, and Deaths for Hospitalized Patients during Coronavirus Disease Pandemic

Shukla¹,

Warde²,

Knott³

et al. 2021

Emerg. Infect. Dis.

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Hospital-acquired infections are emerging major concurrent conditions during the coronavirus disease (COVID-19) pandemic. We conducted a retrospective review of hospitalizations during March‒October 2020 of adults tested by reverse transcription PCR for severe acute respiratory syndrome coronavirus 2. We evaluated associations of COVID-19 diagnosis with risk for laboratory-confirmed bloodstream infections (LCBIs, primary outcome), time to LCBI, and risk for death by using logistic and competing risks regression with adjustment for relevant covariates. A total of 10,848 patients were included in the analysis: 918 (8.5%) were given a diagnosis of COVID-19, and 232 (2.1%) had LCBIs during their hospitalization. Of these patients, 58 (25%) were classified as having central line‒associated bloodstream infections. After adjusting for covariates, COVID-19‒positive status was associated with higher risk for LCBI and death. Reinforcement of infection control practices should be implemented in COVID-19 wards, and review of superiority and inferiority ranking methods by National Healthcare Safety Network criteria might be needed.

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Section: Discussionmentioning

confidence: 99%

Bloodstream Infection Risk, Incidence, and Deaths for Hospitalized Patients during Coronavirus Disease Pandemic

Shukla¹,

Warde²,

Knott³

et al. 2021

Emerg. Infect. Dis.

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“…Prone ventilation has been used frequently in patients with COVID-19 (11.5%) [ 17 ]. In a recent case series of 44 patients, prone positioning increased oxygenation only in patients with partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) <120 mmHg [ 36 ], thus suggesting that the response to pronation strongly depends on the specific pathophysiologic features of each patient with COVID-19 and can help to redistribute pulmonary blood flow and/or reduce atelectasis [ 7 ]. Even though prone position has been proposed [ 37 ], several reports suggest that the beneficial effects are rapidly lost in most patients when repositioned in the supine position [ 38 ].…”

Section: Introductionmentioning

confidence: 99%

Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19

Robba

Battaglini

Ball

et al. 2021

Expert Review of Respiratory Medicine

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Introduction: The ongoing pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed important challenges for clinicians and health-care systems worldwide. Areas covered: The aim of this manuscript is to provide brief guidance for intensive care unit management of mechanically ventilated patients with COVID-19 based on the literature and our direct experience with this population. PubMed, EBSCO, and the Cochrane Library were searched up until 15th of January 2021 for relevant literature. Expert opinion: Initially, the respiratory management of COVID-19 relied on the general therapeutic principles for acute respiratory distress syndrome; however, recent findings have suggested that the pathophysiology of hypoxemia in patients with COVID-19 presents specific features and changes over time. Several therapies, including antiviral and anti-inflammatory agents, have been proposed recently. The optimal intensive care unit management of patients with COVID-19 remains unclear; therefore, ongoing and future clinical trials are warranted to clarify the optimal strategies to adopt in this cohort of patients.

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“…1 The mechanism by which the prone position exerts such beneficial effects are numerous including improved lung homogeneity, alveolar recruitment, ventilation-perfusion mismatch, changes in lung and chest wall compliances, reduced compression on the lungs by the heart and abdominal organs, improved right ventricular function and hemodynamics. 2 Not surprisingly, the prone position has emerged as important maneuver in the fight against SARS-CoV-2 (COVID- 19) in mechanically ventilated patients with moderate to severe ARDS, 3,4 as well as awake and nonmechanically ventilated patients. 5 Given the known benefits of the upright sitting position with head elevated in the supine position on respiratory mechanics 6 and possible reduction in risk of aspiration, 7 most of patients in the prone position have their bed angled up in the reverse Trendelenburg position.…”

Section: Introductionmentioning

confidence: 99%

Effect of Trendelenburg position during prone ventilation in fifteen COVID-19 patients. Observational study

Su¹,

Yamasaki²,

Daoud³

2021

JMV

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Background Prone position ventilation has shown to improve oxygenation and mortality in severe ARDS. The data of prone position ventilation during severe ARDS secondary to COVID-19 have shown similar benefit in oxygenation and mortality. Usually, patient placed in prone position are placed flat or in reverse Trendelenburg positioning to decrease risk of aspiration and abdominal girth compressing the chest. To date, no studies are available to compare the effects of positioning the bed in different angles during the prone position ventilation. Methods An observational study in fifteen patients with severe ARDS secondary to COVID-19 who were placed in the prone position for the first time. All the patients were sedated and chemically paralyzed with no spontaneous effort. All patients were ventilated with the pressure-controlled mode with set PEEP according to the pressure-volume curves. Five patients had esophageal balloon manometry to estimate pleural pressures and trans-pulmonary pressures. Patients were initially placed in reverse Trendelenburg position and later in Trendelenburg position. Tidal volume and respiratory compliance were observed for 30 minutes after bed positioning has been achieved. Tidal volume and total respiratory compliance in both Trendelenburg and reverse Trendelenburg position were compared. Ventilator settings were not changed during the observation. No patients were suspected of increased intra-cranial or intra-ocular pressures. T-test was done to compare the values. Results Tidal volume significantly increased by 80.26 ± 23.4 ml/breath (95% CI 37.7 - 122.9) from 391.3 ± 52.7 to 471.6 ± 60.9 (20.5%) P 0.001. The respiratory system compliance significantly increased by 4.9 ml/cmH2O (95% CI 1.4 - 8.4) from 34.6 ± 4.7 to 39.5 ± 4.6 (14%) P 0.001. Of the five patients with esophageal balloon, the lung compliance significantly increased by 16.7 ml/cmH2O (95% CI 12.8 – 20.6) from 66.6 ± 1.7 to 83.3 ± 3.3 (25%) P 0.001. The chest wall compliance had small but non-significant increase by 1.5 ml/cmH2O (95% CI -1.3 – 4.3) from 65 ± 1.4 to 66.5 ± 2.3 (2%) P 0.085. Conclusion In this study, statistically significant increase in tidal volume, lung and respiratory system compliance were observed in patients placed in the Trendelenburg position during prone position ventilation. The results reflect the effect of body positioning during prone position ventilation. These effects may be the reflection of altered ventilation distribution throughout the lungs and change in pleural pressure as well as trans-pulmonary pressure during body positioning. More studies need to be done to confirm and examine this phenomenon. Precautions should be taken as this maneuver can increase the intra-cranial and intra-ocular pressures. Keywords: COVID-19, Trendelenburg, Reverse Trendelenburg, ARDS

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Prone positioning in mechanically ventilated patients with severe acute respiratory distress syndrome and coronavirus disease 2019

Cited by 37 publications

References 14 publications

Bloodstream Infection Risk, Incidence, and Deaths for Hospitalized Patients during Coronavirus Disease Pandemic

Bloodstream Infection Risk, Incidence, and Deaths for Hospitalized Patients during Coronavirus Disease Pandemic

Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19

Effect of Trendelenburg position during prone ventilation in fifteen COVID-19 patients. Observational study

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