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Extended prone positioning for intubated ARDS: a review

During the COVID-19 pandemic, several centers had independently reported extending prone positioning beyond 24 h. Most of these centers reported maintaining patients in prone position until significant clinical improvement was achieved. One center reported extending prone positioning for organizatio...

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Autores principales: Walter, Thaïs, Ricard, Jean-Damien
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10320968/
https://www.ncbi.nlm.nih.gov/pubmed/37408074
http://dx.doi.org/10.1186/s13054-023-04526-2
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author Walter, Thaïs
Ricard, Jean-Damien
author_facet Walter, Thaïs
Ricard, Jean-Damien
author_sort Walter, Thaïs
collection PubMed
description During the COVID-19 pandemic, several centers had independently reported extending prone positioning beyond 24 h. Most of these centers reported maintaining patients in prone position until significant clinical improvement was achieved. One center reported extending prone positioning for organizational reasons relying on a predetermined fixed duration. A recent study argued that a clinically driven extension of prone positioning beyond 24 h could be associated with reduced mortality. On a patient level, the main benefit of extending prone positioning beyond 24 h is to maintain a more homogenous distribution of the gas–tissue ratio, thus delaying the increase in overdistention observed when patients are returned to the supine position. On an organizational level, extending prone positioning reduces the workload for both doctors and nurses, which might significantly enhance the quality of care in an epidemic. It might also reduce the incidence of accidental catheter and tracheal tube removal, thereby convincing intensive care units with low incidence of ARDS to prone patients more systematically. The main risk associated with extended prone positioning is an increased incidence of pressure injuries. Up until now, retrospective studies are reassuring, but prospective evaluation is needed. GRAPHICAL ABSTRACT: [Image: see text]
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spelling pubmed-103209682023-07-06 Extended prone positioning for intubated ARDS: a review Walter, Thaïs Ricard, Jean-Damien Crit Care Review During the COVID-19 pandemic, several centers had independently reported extending prone positioning beyond 24 h. Most of these centers reported maintaining patients in prone position until significant clinical improvement was achieved. One center reported extending prone positioning for organizational reasons relying on a predetermined fixed duration. A recent study argued that a clinically driven extension of prone positioning beyond 24 h could be associated with reduced mortality. On a patient level, the main benefit of extending prone positioning beyond 24 h is to maintain a more homogenous distribution of the gas–tissue ratio, thus delaying the increase in overdistention observed when patients are returned to the supine position. On an organizational level, extending prone positioning reduces the workload for both doctors and nurses, which might significantly enhance the quality of care in an epidemic. It might also reduce the incidence of accidental catheter and tracheal tube removal, thereby convincing intensive care units with low incidence of ARDS to prone patients more systematically. The main risk associated with extended prone positioning is an increased incidence of pressure injuries. Up until now, retrospective studies are reassuring, but prospective evaluation is needed. GRAPHICAL ABSTRACT: [Image: see text] BioMed Central 2023-07-05 /pmc/articles/PMC10320968/ /pubmed/37408074 http://dx.doi.org/10.1186/s13054-023-04526-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Review
Walter, Thaïs
Ricard, Jean-Damien
Extended prone positioning for intubated ARDS: a review
title Extended prone positioning for intubated ARDS: a review
title_full Extended prone positioning for intubated ARDS: a review
title_fullStr Extended prone positioning for intubated ARDS: a review
title_full_unstemmed Extended prone positioning for intubated ARDS: a review
title_short Extended prone positioning for intubated ARDS: a review
title_sort extended prone positioning for intubated ards: a review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10320968/
https://www.ncbi.nlm.nih.gov/pubmed/37408074
http://dx.doi.org/10.1186/s13054-023-04526-2
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