Prone Positioning for ARDS Patients-tips for Preparation and Use During the COVID-19 Pandemic

Overview

Journal Can J Anaesth

Specialty Anesthesiology

Date 2020 Dec 28

PMID 33367994

Citations 10

Authors

Ken Kuljit S Parhar

Danny J Zuege

Karen Shariff

Gwen Knight

Sean M Bagshaw

Affiliations

Soon will be listed here.

Abstract

Many patients with coronavirus disease (COVID-19) will develop acute respiratory distress syndrome (ARDS). Prone positioning is an important non-pharmacologic strategy that should be considered for all invasively ventilated patients with moderate to severe ARDS (including those with COVID-19). Prone positioning offers several physiologic and clinical benefits, including improving hypoxemia, matching ventilation with perfusion, reducing regional hyperinflation, and improving survival. To safely offer prone positioning, appropriate training, simulation, and health system planning should be undertaken. In this review, we offer ten tips, based on the Alberta provincial prone positioning strategy during COVID-19, to safely implement and improve the appropriate use of prone positioning. We provide special considerations for its use during the COVID-19 pandemic or future respiratory pandemics.

Citing Articles

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[Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19].

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Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19.

Perez-Juan E, Maqueda-Palau M, Feliu-Roig C, Gomez-Arroyo J, Saez-Romero D, Ortiz-Monjo A Enferm Intensiva (Engl Ed). 2023; 34(4):176-185.

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References

Kallet R . A Comprehensive Review of Prone Position in ARDS. Respir Care. 2015; 60(11):1660-87. DOI: 10.4187/respcare.04271. View

Scholten E, Beitler J, Prisk G, Malhotra A . Treatment of ARDS With Prone Positioning. Chest. 2016; 151(1):215-224. PMC: 6026253. DOI: 10.1016/j.chest.2016.06.032. View

Gattinoni L, Busana M, Giosa L, Macri M, Quintel M . Prone Positioning in Acute Respiratory Distress Syndrome. Semin Respir Crit Care Med. 2019; 40(1):94-100. DOI: 10.1055/s-0039-1685180. View

Chiumello D, Brochard L, Marini J, Slutsky A, Mancebo J, Ranieri V . Respiratory support in patients with acute respiratory distress syndrome: an expert opinion. Crit Care. 2017; 21(1):240. PMC: 5596474. DOI: 10.1186/s13054-017-1820-0. View

Fan E, Del Sorbo L, Goligher E, Hodgson C, Munshi L, Walkey A . An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2017; 195(9):1253-1263. DOI: 10.1164/rccm.201703-0548ST. View

Guerin C, Reignier J, Richard J, Beuret P, Gacouin A, Boulain T . Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013; 368(23):2159-68. DOI: 10.1056/NEJMoa1214103. View

Mentec H, Dupont H, Bocchetti M, CANI P, Ponche F, Bleichner G . Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med. 2001; 29(10):1955-61. DOI: 10.1097/00003246-200110000-00018. View

Guerin C, Beuret P, Constantin J, Bellani G, Garcia-Olivares P, Roca O . A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study. Intensive Care Med. 2017; 44(1):22-37. DOI: 10.1007/s00134-017-4996-5. View

Bhatraju P, Ghassemieh B, Nichols M, Kim R, Jerome K, Nalla A . Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. N Engl J Med. 2020; 382(21):2012-2022. PMC: 7143164. DOI: 10.1056/NEJMoa2004500. View

10.

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A . Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020; 323(16):1574-1581. PMC: 7136855. DOI: 10.1001/jama.2020.5394. View

11.

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H . Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8(5):475-481. PMC: 7102538. DOI: 10.1016/S2213-2600(20)30079-5. View

12.

Mazer S, Weisfeldt M, Bai D, Cardinale C, Arora R, Ma C . Reverse CPR: a pilot study of CPR in the prone position. Resuscitation. 2003; 57(3):279-85. DOI: 10.1016/s0300-9572(03)00037-6. View