Critically Ill Patients with COVID-19: A Narrative Review on Prone Position
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REVIEW
Critically Ill Patients with COVID-19: A Narrative Review on Prone Position Syeda Kashfi Qadri . Priscilla Ng . Theresa Shu Wen Toh . Sin Wee Loh . Herng Lee Tan . Cheryl Bin Lin . Eddy Fan . Jan Hau Lee
Received: August 18, 2020 / Accepted: September 26, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Prone position is known to improve mortality in patients with acute respiratory distress syndrome (ARDS). The impact of prone position in critically ill patients with coronavirus disease of 2019 (COVID-19) remains to be determined. In this review, we describe the mechanisms of action of prone position, systematically appraise the current experience of prone position in COVID-19 patients, and highlight unique considerations for prone position practices during this pandemic. Methods: For our systematic review, we searched PubMed, Scopus and EMBASE from S. K. Qadri (&) H. L. Tan C. B. Lin J. H. Lee Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore e-mail: [email protected] S. K. Qadri P. Ng J. H. Lee Duke NUS Medical School, 8 College Road, Singapore 169857, Singapore T. S. W. Toh S. W. Loh Department of Pediatrics, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore E. Fan Interdepartmental Division of Critical Care Medicine, University of Toronto, 204 Victoria Street, 4th Floor, Room 411, Toronto, ON M5B1T8, Canada
January 1, 2020, to April 16, 2020. After completion of our search, we became aware of four relevant publications during article preparation that were published in May and June 2020, and these studies were reviewed for eligibility and inclusion. We included all studies reporting clinical characteristics of patients admitted to the hospital with COVID-19 disease who received respiratory support with high-flow nasal cannula, or noninvasive or mechanical ventilation and reported the use of prone position. The full text of eligible articles was reviewed, and data regarding study design, patient characteristics, interventions and outcomes were extracted. Results: We found seven studies (total 1899 patients) describing prone position in COVID19. Prone position has been increasingly used in non-intubated patients with COVID-19; studies show high tolerance and improvement in oxygenation and lung recruitment. Published studies lacked a description of important clinical outcomes (e.g., mortality, duration of mechanical ventilation). Conclusions: Based on the findings of our review, we recommend prone position in patients with moderate to severe COVID-19 ARDS as per existing guidelines. A trial of prone position should be considered for non-intubated COVID-19 patients with hypoxemic respiratory failure, as long as this does not result in a delay in intubation.
Pulm Ther
Keywords: Acute respiratory distress syndrome (ARDS); COVID-19; Epidemic; Pandemic; Prone position Key Summary Points Prone position improves mortality in patients wi
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