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2022, Number 4

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Med Crit 2022; 36 (4)

Prono position: a non-ventilatory strategy in patients with severe pneumonia due to SARS-CoV-2

Vargas GIJ, Sánchez DJS, Peniche MKG, González EEA, García GVD, Calyeca SMV

Language: Spanish
References: 26
Page: 197-201
PDF size: 249.28 Kb.


ABSTRACT

Introduction: Severe pneumonia due to SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) causes severe hypoxemia, therefore, the guidelines for the management of critically ill adult patients with COVID-19 recommend the use of the prone position to improve oxygenation. Material and methods: A prospective, descriptive and analytical cohort study. Patients admitted to the intensive care unit in the period from April 18, 2020 to August 18, 2021 with confirmed IMV secondary to severe SARS-CoV-2 pneumonia. Results: In the period covered, 110 patients who met the inclusion criteria were included. Of the total, 88 patients were included in the group with sustained improvement at prone withdrawal and 22 in the group with non-sustained improvement at prone withdrawal. It was observed that the% Decrease in PaO2/FiO2 upon prone removal is useful to predict mortality with AUC of 0.740 with 95% CI of (0.646-0.834) and p = 0.001. Conclusion: A > 50% decrease in PaO2/FiO2 upon removal from prolonged prone position or unsustained improvement is a predictor of mortality in patients with severe SARS-CoV-2 pneumonia.


REFERENCES

  1. Vaduganathan M, Vardeny O, Michel T, et al. Renin-angiotensin-aldosterone system inhibitors in patients with covid-19. N Engl J Med. 2020;382(17):1653-1659.

  2. Yang X, Yu Y, Xu J, et al. 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.

  3. Singh AK, Gupta R, Ghosh A, Misra A. Diabetes in COVID-19: prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr Clin Res Rev. 2020;14:303-310.

  4. Alhazzani W, Moller MH, Arabi YM, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020;46(5):854-887.

  5. Guérin C, Reignier J, Richard J, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159-2168.

  6. Munshi L, Del Sorbo L, Adhikari NKJ, et al. Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Ann Am Thorac Soc. 2017;14(Supplement_4):S280-S288.

  7. Guérin C, Constantin JM, Bellani G, et al. A prospective international observational prevalence study on prone positioning of ARDS patients: The APRONET (ARDS Prone Position Network) study. Intensive Care Med. 2018;44:22-37.

  8. Ramírez P, Gordón M, Martín-Cerezuela M, et al. Acute respiratory distress syndrome due to COVID-19. Clinical and prognostic features from a medical Critical Care Unit in Valencia, Spain. Med Intensiva. 2021;45:27-34.

  9. Guérin C, Albert RK, Beitler J, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med. 2020;46(12):2385-2396.

  10. Carsetti A, Damia Paciarini A, Marini B, Pantanetti S, Adrario E, Donati A. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective. Crit Care. 2020;24(1):225.

  11. Azoulay E, De Waele J, Ferrer R, et al. Symptoms of burnout in intensive care unit specialists facing the COVID-19 outbreak. Ann. Intensive Care. 2020;10:110.

  12. Piehl MA, Brown RS. Use of extreme position changes in acute respiratory failure. Crit Care Med. 1976;4(1):13-14.

  13. Lee HY, Cho J, Kwak N, et al. Improved oxygenation after prone positioning may be a predictor of survival in patients with acute respiratory distress syndrome. Crit Care Med. 2020;48(12):1729-1736.

  14. Pelosi P, Brazzi L, Gattinoni L. Prone position in acute respiratory distress syndrome. Eur Respir J. 2002;20:1017-1028.

  15. Chiumello D, Carlesso E, Cadringher P, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med. 2008;5;178(4):346-355.

  16. Lee HY, Cho J, Kwak N, et al. Improved oxygenation after prone positioning may be a predictor of survival in patients with acute respiratory distress syndrome. Crit Care Med. 2020;48(12):1729-1736.

  17. Gattinoni L, Vagginelli F, Carlesso E, et al. Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Crit Care Med. 2003;31:2727-2733.

  18. Peterson LN, Gattinoni L. Response to proning in moderate to severe acute respiratory distress syndrome: a new talking point in an ongoing conversation. Crit Care Med. 2020;48(12):1889-1891.

  19. Kopterides P, Siempos II, Armaganidis A. Prone positioning in hypoxemic respiratory failure: meta-analysis of randomized controlled trials. J Crit Care. 2009;24:89-100.

  20. Scaramuzzo G, Gamberini L, Tonetti, T. et al. Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study. Ann Intensive Care. 2021;11:63.

  21. The Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301-1308.

  22. Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial I. Cavalcanti AB, Suzumura EA, et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2017;318(14):1335-1345.

  23. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42(10):1567-1575.

  24. Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372:747-755.

  25. Sinha P, Singh S, Hardman JG, Australia and New Zealand Intensive Care Society Clinical Trials Group. Evaluation of the physiological properties of ventilatory ratio in a computational cardiopulmonary model and its clinical application in an acute respiratory distress syndrome population. Br J Anaesth. 2014;112(1):96-101.

  26. Camporota L, Sanderson B, Chiumello D, et al. Prone position in COVID-19 and -COVID-19 acute respiratory distress syndrome: an international multicenter observational comparative study. Crit Care Med. 2022;50(4):633-643.




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