Prone positioning of nonintubated patients with acute hypoxemic respiratory failure

Li, Jie; Roca, Oriol; Ehrmann, Stéphan

doi:10.1097/mcc.0000000000001009

Cited by 5 publications

(3 citation statements)

References 45 publications

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“…The application of APP has shifted from patients undergoing vertebral body surgery, awake fiber-optic intubation, and lung transplantation [ 6 – 8 ] to non-intubated ARDS patients, which was supported by clinical guidelines and expert consensus statements [ 9 – 11 ]. The optimal duration of APP sessions remains uncertain, but previous studies indicated at least 8 h of daily prone position may be beneficial [ 2 , 12 ]. A recent meta-analysis of over 4,000 COVID-19 patients revealed that the actual duration of APP varied significantly, ranging from 1–2 h to 8–10 h per day [ 13 ], which may potentially affect the effectiveness of treatment [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators of adherence to awake prone positioning: a qualitative study using the COM-B model

Zhu

Zhang

et al. 2023

BMC Pulm Med

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Background Awake prone positioning (APP) is a recommended therapy for non-intubated ARDS patients, but adherence can be challenging. Understanding the barriers and facilitators of adherence to APP is essential to increase the adherence of therapy and improve patient outcomes. The objective of this study was to explore the barriers and facilitators of adherence to awake prone ventilation using a qualitative approach and the Capability, Opportunity, Motivation-Behavior (COM-B) model. Methods Semi-structured, in-depth interviews were conducted with patients involved in awake prone ventilation. Data were analyzed using an adapted inductive thematical approach and mapped onto the COM-B model to identify barriers and facilitators to adherence of APP. Results Nineteen patients were interviewed (aged 55–92 years). Fifteen themes were identified and mapped directly on to the six COM-B constructs, with “physical challenges” related to physical capability being the primary barrier. These COM-B sub-items reflected five other barriers, including low self-efficacy(M), treatment environment(O), availability of time(O), misconceptions about the treatment(C), and insufficient knowledge(C). Key facilitators in adhering to APP were ability to identify and overcome obstacles(C), availability and affordability of treatment(O), family influences(O), beliefs and trust in treatment(M), fear about the disease(M), and perceived benefits(M). In addition, three factors played the role of both facilitator and barrier, such as media influences(O), healthcare influences(O), and behavioral habits(M). Conclusion The COM-B model was proved to be a useful framework for identifying the barriers and facilitators of adherence to awake prone ventilation. The findings suggest that adherence behavior is a dynamic and balanced process and interventions aimed at improving adherence to APP should address the barriers related to capability, opportunity, and motivation. Healthcare providers should focus on providing proper guidance and training, creating a comfortable environment, and offering social support to improve patients’ capability and opportunity. Additionally, promoting patients’ positive beliefs and attitudes towards the treatment and addressing misconceptions and fears can further enhance patients’ motivation to adhere to the treatment plan.

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Section: Introductionmentioning

confidence: 99%

Barriers and facilitators of adherence to awake prone positioning: a qualitative study using the COM-B model

Zhu

Zhang

et al. 2023

BMC Pulm Med

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“…3,4 In particular, awake PP (APP), which involves placing non-intubated patients in PP, has become popular due to its ease of implementation and the overwhelming need for avoiding intubation. [5][6][7] This review will discuss relevant findings from recent publications on the use of PP and APP for patients with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Prone Positioning for Patients With COVID-19–Induced Acute Hypoxemic Respiratory Failure: Flipping the Script

Li,

Ibarra-Estrada,

Guérin

2023

Respir Care

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During the COVID-19 pandemic, prone positioning (PP) emerged as a widely used supportive therapy for patients with acute hypoxemic respiratory failure caused by COVID-19 infection. In particular, awake PP (APP)-the placement of non-intubated patients in the prone position-has gained popularity and hence is detailed first herein. This review discusses recent publications on the use of PP for non-intubated and intubated subjects with COVID-19, highlighting the physiological responses, clinical outcomes, influential factors affecting treatment success, and strategies to improve adherence with APP. The use of prolonged PP and the use of PP for patients undergoing extracorporeal membrane oxygenation are also presented.

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“…Oxygenation improvement and changes in the lung ultrasound findings may help to identify those individuals more likely to avoid intubation. 25 …”

mentioning

confidence: 99%

A new gambler at the table of management of COVID-19 associated acute respiratory failure. Changing position to do it better?

Crimi

Ambrosino

2023

Pulmonology

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Prone positioning of nonintubated patients with acute hypoxemic respiratory failure

Cited by 5 publications

References 45 publications

Barriers and facilitators of adherence to awake prone positioning: a qualitative study using the COM-B model

Barriers and facilitators of adherence to awake prone positioning: a qualitative study using the COM-B model

Prone Positioning for Patients With COVID-19–Induced Acute Hypoxemic Respiratory Failure: Flipping the Script

A new gambler at the table of management of COVID-19 associated acute respiratory failure. Changing position to do it better?

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