Awake prone positioning in acute hypoxaemic respiratory failure.
Bairbre A McNicholasMiguel Á Ibarra-EstradaYonatan PerezJie LiIvan PavlovAileen KharatDavid L VinesOriol RocaDavid CosgraveNicolas TerziStephan EhrmannJohn Gerard LaffeyPublished in: European respiratory review : an official journal of the European Respiratory Society (2023)
Awake prone positioning (APP) of patients with acute hypoxaemic respiratory failure gained considerable attention during the early phases of the coronavirus disease 2019 (COVID-19) pandemic. Prior to the pandemic, reports of APP were limited to case series in patients with influenza and in immunocompromised patients, with encouraging results in terms of tolerance and oxygenation improvement. Prone positioning of awake patients with acute hypoxaemic respiratory failure appears to result in many of the same physiological changes improving oxygenation seen in invasively ventilated patients with moderate-severe acute respiratory distress syndrome. A number of randomised controlled studies published on patients with varying severity of COVID-19 have reported apparently contrasting outcomes. However, there is consistent evidence that more hypoxaemic patients requiring advanced respiratory support, who are managed in higher care environments and who can be prone for several hours, benefit most from APP use. We review the physiological basis by which prone positioning results in changes in lung mechanics and gas exchange and summarise the latest evidence base for APP primarily in COVID-19. We examine the key factors that influence the success of APP, the optimal target populations for APP and the key unknowns that will shape future research.
Keyphrases
- respiratory failure
- extracorporeal membrane oxygenation
- acute respiratory distress syndrome
- coronavirus disease
- mechanical ventilation
- sars cov
- intensive care unit
- respiratory syndrome coronavirus
- healthcare
- end stage renal disease
- deep brain stimulation
- type diabetes
- ejection fraction
- palliative care
- metabolic syndrome
- prognostic factors
- emergency department
- peritoneal dialysis
- randomized controlled trial
- chronic kidney disease
- early onset
- high intensity
- drug induced
- hepatitis b virus
- adipose tissue
- carbon dioxide
- blood flow
- current status
- pain management
- patient reported outcomes
- quality improvement