Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series

Sahoo, Jyoti Narayan; Gurjar, Mohan; Mohanty, Krantimaya; Majhi, Kalpana; Sradhanjali, G

doi:10.4103/ijciis.ijciis_62_18

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…However, in two recent reports, it was surprising that between 13.1% 51 and 14.5% 52 of patients with COVID-19 had peripheral nerve injury after prone positioning, including injuries to the brachial plexus, ulnar, radial, sciatic, and median nerves. In our review, only four studies reported a pooled proportion of any peripheral nerve injury (8.1%) 43,49,52,53 , which could indicate an underestimation in other studies.…”

Section: Discussionmentioning

confidence: 73%

“…Owing to the wide coverage of scoping reviews, we identified additional AEs from nonrandomized controlled trials and compared the data with preceding randomized controlled trials [23][24][25][26] . From single studies, we identified back pain 43 , barotrauma 44 , vomit 45 , hemoptysis 10 , and bleeding 45 as AEs. Additionally, we found relevant AEs reported in at least two original studies that were not informed by previous reviews 23,24 .…”

Section: Discussionmentioning

confidence: 99%

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Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS

et al. 2021

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INTRODUCTION: Prone positioning is a therapy utilized globally to improve gas exchange, minimize ventilator-induced lung injury, and reduce mortality in acute respiratory distress syndrome (ARDS), particularly during the ongoing coronavirus disease 2019 (COVID-19) pandemic. While the respiratory benefits of prone positioning in ARDS have been accepted, the concurrent complications could be undervalued. Therefore, this study aimed to identify the adverse events related to prone positioning in ARDS, and secondarily, to collect strategies and recommendations to mitigate these adverse events. METHODS: In this scoping review, we searched recommendation documents and original studies published between June 2013 and November 2020 from six relevant electronic databases and the websites of intensive care societies. RESULTS: We selected 41 documents from 121 eligible documents, comprising 13 recommendation documents and 28 original studies (involving 1,578 patients and 994 prone maneuvers). We identified more than 40 individual adverse events, and the highest pooled occurrence rates were that of severe desaturation (37.9%), barotrauma (30.5%), pressure sores (29.7%), ventilationassociated pneumonia (28.2%), facial edema (16.7%), arrhythmia (15.4%), hypotension (10.2%), and peripheral nerve injuries (8.1%). The reported mitigation strategies during prone positioning include alternate face rotation (18 [43.9%]), repositioning every 2 hours (17 [41.5%]), and the use of pillows under the chest and pelvis (14 [34.1%]). The reported mitigation strategies for performing the prone maneuver comprise one person being at the headboard (23 [56.1%]), the use of a pre-maneuver safety checklist (18 [43.9%]), vital sign monitoring (15 [36.6%]), and ensuring appropriate ventilator settings (12 [29.3%]). CONCLUSIONS: We identified >40 adverse events reported in prone positioning ARDS studies, involving additional AEs not yet reported by previous systematic reviews. The Page 3 of 43 Respiratory Care 4 pooled adverse event proportions collected in this review could guide research and clinical practice decisions, and the strategies to mitigate adverse events could promote future consensus-based recommendations.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS

et al. 2021

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“…In studies since 2010, the overall rates of mortality in ARDS patients in an ICU were shown to be 38% and the 28 day mortality to be 30% [ 28 ]. In a subgroup of ARDS with H1N1 viral infection, a mortality of 36–38% has been reported [ 29 ]. In comparison to H1N1, as well as a meta-analysis of ARDS patients, there was a significantly increased mortality rate in our SARS-CoV-2 patient cohort.…”

Section: Discussionmentioning

confidence: 99%

Prone Position in Mechanically Ventilated COVID-19 Patients: A Multicenter Study

Vollenberg

Matern

Nowacki

et al. 2021

JCM

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Background: The prone position (PP) is increasingly used in mechanically ventilated coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) patients. However, studies investigating the influence of the PP are currently lacking in these patients. This is the first study to investigate the influence of the PP on the oxygenation and decarboxylation in COVID-19 patients. Methods: A prospective bicentric study design was used, and in mechanically ventilated COVID-19 patients, PP was indicated from a partial pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FIO2) ratio of <200. Patients were left prone for 16 h each. Pressure levels, FIO2, were adjusted to ensure a PaO2 greater than 60 mmHg. Blood gas analyses were performed before (baseline 0.5 h), during (1/2/5.5/9.5/13 h), and after being in the PP (1 h), the circulatory/ventilation parameters were continuously monitored, and lung compliance (LC) was roughly calculated. Responders were defined compared to the baseline value (PaO2/FIO2 ratio increase of ≥15%; partial pressure of carbon dioxide (PaCO2) decrease of ≥2%). Results: 13 patients were included and 36 PP sessions were conducted. Overall, PaO2/FIO2 increased significantly in the PP (p < 0.001). Most PaO2/FIO2 responders (29/36 PP sessions, 77%) were identified 9.5 h after turning prone (14% slow responders), while most PaCO2 responders (15/36 PP sessions, 42%) were identified 13 h after turning prone. A subgroup of patients (interval intubation to PP ≥3 days) showed less PaO2/FIO2 responders (16% vs. 77%). An increase in PaCO2 and minute ventilation in the PP showed a significant negative correlation (p < 0.001). LC (median before the PP = 38 mL/cm H2O; two patients with LC >80 mL/cm H2O) showed a significant positive correlation with the 28 day survival of patients (p = 0.01). Conclusion: The PP significantly improves oxygenation in COVID-19 ARDS patients. The data suggest that they also benefit most from an early PP. A decrease in minute ventilation may result in fewer PaCO2 responders. LC may be a predictive outcome parameter in COVID-19 patients. Trial registration: Retrospectively registered.

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“…It was shown previously in H1N1-infected patients with severe ARDS that starting prone-position MV early and applying it for an adequate duration improves oxygenation. 13 Prone positioning is a beneficial strategy in patients with ARDS because it improves alveolar recruitment and the ventilation/perfusion ratio while reducing lung strain, resulting in improved oxygenation, reduced lung injury, and reduced mortality risk. 14 In the present case, we placed our patient in a prone position for 12 h/day for 5 days at the commencement of MV, and observed steady improvement in his PaO 2 /FiO 2 followed by a prompt recovery and good outcome.…”

Section: Discussionmentioning

confidence: 99%

A critical COVID-19 patient managed with timely evaluation, early prone positioning ventilation, and a multi-pronged pharmacotherapy

Peng

Cao

et al. 2021

Eur J Inflamm

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There is not yet a standard drug regimen for the treatment of coronavirus disease 2019 (COVID-19) patients. Here, we summarize our experience and successful treatment plan with a critical COVID-19 patient who required mechanical ventilation (MV). A 56-year-old man presented with a fever, cough, and dyspnea. He had not been to a medium/high risk epidemic area in the past year and had no family history of a disease cluster. COVID-19 was suspected based on clinical symptoms and radiologically detected ground-glass lung changes in the context of a normal white blood cell count (WBCC) and lymphocyte fraction (L%). A diagnosis of COVID-19 was confirmed by nucleic acid testing. Initially, he was started on noninvasive ventilation (NIV). Because his respiratory distress worsened over the following 2 h, he was transitioned to mechanical ventilation (MV), placed in prone positioning 12 h/day, and given a multi-pronged pharmacotherapy regimen that included an antiviral cocktail (lopinavir/ritonavir plus α-interferon), an immunity enhancer (thymosin α1), an anti-coagulant to prevent thrombosis (heparin). He was given an antibiotic to treat an opportunistic nosocomial infection. The patient has recovered well. The regimen applied in this case of timely evaluation, early prone positioning with MV, and a multi-pronged pharmacotherapy may be an effective strategy for patients with critical COVID-19, particularly with respect to preventing life-threatening worsening of the illness.

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Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series

Cited by 7 publications

References 33 publications

Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS

Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS

Prone Position in Mechanically Ventilated COVID-19 Patients: A Multicenter Study

A critical COVID-19 patient managed with timely evaluation, early prone positioning ventilation, and a multi-pronged pharmacotherapy

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