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Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19

Hypoxemia of the acute respiratory distress syndrome can be reduced by turning patients prone. Prone positioning (PP) is labor intensive, risks unplanned tracheal extubation, and can result in facial tissue injury. We retrospectively examined prolonged, repeated, and early versus later PP for 20 pat...

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Autores principales: Parker, Elizabeth M., Bittner, Edward A., Berra, Lorenzo, Pino, Richard M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267703/
https://www.ncbi.nlm.nih.gov/pubmed/34279453
http://dx.doi.org/10.3390/jcm10132969
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author Parker, Elizabeth M.
Bittner, Edward A.
Berra, Lorenzo
Pino, Richard M.
author_facet Parker, Elizabeth M.
Bittner, Edward A.
Berra, Lorenzo
Pino, Richard M.
author_sort Parker, Elizabeth M.
collection PubMed
description Hypoxemia of the acute respiratory distress syndrome can be reduced by turning patients prone. Prone positioning (PP) is labor intensive, risks unplanned tracheal extubation, and can result in facial tissue injury. We retrospectively examined prolonged, repeated, and early versus later PP for 20 patients with COVID-19 respiratory failure. Blood gases and ventilator settings were collected before PP, at 1, 7, 12, 24, 32, and 39 h after PP, and 7 h after completion of PP. Analysis of variance was used for comparisons with baseline values at supine positions before turning prone. PP for >39 h maintained PaO(2)/FiO(2) (P/F) ratios when turned supine; the P/F decrease at 7 h was not significant from the initial values when turned supine. Patients turned prone a second time, when again turned supine at 7 h, had significant decreased P/F. When PP started for an initial P/F ≤ 150 versus P/F > 150, the P/F increased throughout the PP and upon return to supine. Our results show that a single turn prone for >39 h is efficacious and saves the burden of multiple prone turns, and there is no significant advantage to initiating PP when P/F > 150 compared to P/F ≤ 150.
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spelling pubmed-82677032021-07-10 Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19 Parker, Elizabeth M. Bittner, Edward A. Berra, Lorenzo Pino, Richard M. J Clin Med Article Hypoxemia of the acute respiratory distress syndrome can be reduced by turning patients prone. Prone positioning (PP) is labor intensive, risks unplanned tracheal extubation, and can result in facial tissue injury. We retrospectively examined prolonged, repeated, and early versus later PP for 20 patients with COVID-19 respiratory failure. Blood gases and ventilator settings were collected before PP, at 1, 7, 12, 24, 32, and 39 h after PP, and 7 h after completion of PP. Analysis of variance was used for comparisons with baseline values at supine positions before turning prone. PP for >39 h maintained PaO(2)/FiO(2) (P/F) ratios when turned supine; the P/F decrease at 7 h was not significant from the initial values when turned supine. Patients turned prone a second time, when again turned supine at 7 h, had significant decreased P/F. When PP started for an initial P/F ≤ 150 versus P/F > 150, the P/F increased throughout the PP and upon return to supine. Our results show that a single turn prone for >39 h is efficacious and saves the burden of multiple prone turns, and there is no significant advantage to initiating PP when P/F > 150 compared to P/F ≤ 150. MDPI 2021-07-01 /pmc/articles/PMC8267703/ /pubmed/34279453 http://dx.doi.org/10.3390/jcm10132969 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Parker, Elizabeth M.
Bittner, Edward A.
Berra, Lorenzo
Pino, Richard M.
Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19
title Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19
title_full Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19
title_fullStr Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19
title_full_unstemmed Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19
title_short Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19
title_sort efficiency of prolonged prone positioning for mechanically ventilated patients infected with covid-19
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267703/
https://www.ncbi.nlm.nih.gov/pubmed/34279453
http://dx.doi.org/10.3390/jcm10132969
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