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Pulmonary
Awake prone positioning for COVID-19 acute hypoxemic respiratory failure in Tunisia
Khaoula Ben Ismail, Fatma Essafi, Imen Talik, Najla Ben Slimene, Ines Sdiri, Boudour Ben Dhia, Takoua Merhbene
Acute Crit Care. 2023;38(3):271-277.   Published online August 21, 2023
DOI: https://doi.org/10.4266/acc.2023.00591
  • 1,760 View
  • 116 Download
AbstractAbstract PDF
Background
In this study, we explored whether awake prone position (PP) can impact prognosis of severe hypoxemia coronavirus disease 2019 (COVID-19) patients.
Methods
This was a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. Patients were divided into two groups: group G1, patients who benefited from a vigilant and effective PP (>4 hours minimum/24) and group G2, control group. We compared demographic, clinical, paraclinical and evolutionary data.
Results
Three hundred forty-nine patients were hospitalized during the study period, 273 met the inclusion criteria. PP was performed in 192 patients (70.3%). The two groups were comparable in terms of demographic characteristics, clinical severity and modalities of oxygenation at intensive care unit (ICU) admission. The mean PaO2/ FIO2 ratios were 141 and 128 mm Hg, respectively (P=0.07). The computed tomography scan was comparable with a critical >75% in 48.5% (G1) versus 54.2% (G2). The median duration of the daily PP session was 13±7 hours per day. The average duration of spontaneous PP days was 7 days (4–19). Use of invasive ventilation was lower in the G1 group (27% vs. 56%, P=0.002). Healthcare-associated infections were significantly lower in G1 (42.1% vs. 82%, P=0.01). Duration of total mechanical ventilation and length of ICU stay were comparable between the two groups. Mortality was significantly higher in G2 (64% vs. 28%, P=0.02).
Conclusions
Our study confirmed that awake PP can improve prognosis in COVID-19 patients. Randomized controlled trials are needed to confirm this result.
Pulmonary
Impact of prone position on outcomes of COVID-19 patients with spontaneous breathing
Mabrouk Bahloul, Sana Kharrat, Malek Hafdhi, Anis Maalla, Olfa Turki, Kamilia Chtara, Rania Ammar, Basma Suissi, Chokri Ben Hamida, Hedi Chelly, Khaiereddine Ben Mahfoudh, Mounir Bouaziz
Acute Crit Care. 2021;36(3):208-214.   Published online August 12, 2021
DOI: https://doi.org/10.4266/acc.2021.00500
  • 5,643 View
  • 209 Download
  • 6 Web of Science
  • 8 Crossref
AbstractAbstract PDF
Background
In this study, we explored whether early application of the prone position (PP) can improve severe hypoxemia and respiratory failure in coronavirus disease 2019 (COVID-19) patients with spontaneous breathing.
Methods
This is a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. All vital parameters were recorded in real time for all patients. Moreover, the results of chest computed tomography (CT), when available, were analyzed.
Results
PP was applied in 21 patients who were breathing spontaneously. The application of PP was associated with a significant increase in oxygen saturation measured by pulse oximetry (SpO2) from 82%±12% to 96%±3% (P<0.001) 1 hour later. Moreover, PP was associated with a significant reduction in respiratory rate from 31±10 to 21±4 breaths/min (P<0.001). Furthermore, the number of patients who exhibited signs of respiratory distress after PP was reduced from 10 (47%) to 3 (14%) (P=0.04). Early PP application also led to a clear improvement on CT imaging. It was not, however, associated with a reduction in mortality rate or in the use of invasive mechanical ventilation (P>0.05 for both).
Conclusions
Our study confirmed that the early application of PP can improve hypoxemia and tachypnea in COVID-19 patients with spontaneous breathing. Randomized controlled trials are needed to confirm the beneficial effects of PP in COVID-19 patients with spontaneous breathing.

Citations

Citations to this article as recorded by  
  • Awake prone positioning for patients with COVID-19-related respiratory failure: a systematic review and meta-analysis
    Mara Graziani, Andrea Galeazzo Rigutini, Diletta Bartolini, Laura Traballi, Lorenzo Luzi, Rossana Regina, Francesco Bossi, Carla Caponi, Cecilia Becattini
    Internal and Emergency Medicine.2024; 19(1): 147.     CrossRef
  • Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
    Gustavo Adolfo Vásquez-Tirado, Edinson Dante Meregildo-Rodríguez, Martha Genara Asmat-Rubio, María José Salazar-Castillo, Claudia Vanessa Quispe-Castañeda, María del Carmen Cuadra-Campos
    Critical Care Science.2024;[Epub]     CrossRef
  • Prone positioning in awake patients without ventilatory support does not alter major clinical outcomes in severe COVID-19: results from a retrospective observational cohort study, systematic review and meta-analysis
    Raíssa S. Freire, Camila M. S. S. Barros, Jefferson Valente, Cássia da Luz Goulart, Anna G. R. Santos, Fernando H. Fonseca, Sabrina T. Saenz, Andiana S. Dias, Maria G. A. Rodrigues, Bernardo Maia Silva, Eduardo Fernandes, Nadia Cubas-Vega, Vanderson Sampa
    Expert Review of Respiratory Medicine.2024; : 1.     CrossRef
  • Awake prone positioning for COVID-19 acute hypoxemic respiratory failure in Tunisia
    Khaoula Ben Ismail, Fatma Essafi, Imen Talik, Najla Ben Slimene, Ines Sdiri, Boudour Ben Dhia, Takoua Merhbene
    Acute and Critical Care.2023; 38(3): 271.     CrossRef
  • Gravity-induced ischemia in the brain-and prone positioning for COVID-19 patients breathing spontaneously
    J. Howard Jaster, Giulia Ottaviani
    Acute and Critical Care.2022; 37(1): 131.     CrossRef
  • Gravity-induced ischemia in the brain and prone positioning for COVID-19 patients breathing spontaneously: still far from the truth!
    Mabrouk Bahloul, Sana Kharrat, Kamilia Chtara, Hedi Chelly, Chokri Ben Hamida, Mounir Bouaziz
    Acute and Critical Care.2022; 37(1): 134.     CrossRef
  • A Case of COVID-19 with Acute Exacerbation after Anti-Inflammatory Treatment
    Yugo Ashino, Yoichi Shirato, Masahiro Yaegashiwa, Satoshi Yamanouchi, Noriko Miyakawa, Kokichi Ando, Yumiko Sakurada, Haorile Chagan Yasutan, Toshio Hattori
    Reports.2022; 5(2): 24.     CrossRef
  • Efficacy and safety of prone position in COVID-19 patients with respiratory failure: a systematic review and meta-analysis
    Hyeon-Jeong Lee, Junghyun Kim, Miyoung Choi, Won-Il Choi, Joonsung Joh, Jungeun Park, Joohae Kim
    European Journal of Medical Research.2022;[Epub]     CrossRef

ACC : Acute and Critical Care