Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure : Guidance from an International Group of Healthcare Workers
Stilma, Willemke (Amsterdam University of Applied Science)
Åkerman, Eva (Karolinska University Hospital and Karolinska Institutet (Suècia))
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Bentley, Andrew (Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom)
Bos, Lieuwe D.. (Department of Intensive Care, Amsterdam University Medical Centers)
Bosman, Thomas J. C. (Department of Intensive Care, Amsterdam University Medical Centers)
de Bruin, Hendrik (Department of Intensive Care, Amsterdam University Medical Centers)
Brummaier, Tobias (University of Oxford. Centre for Tropical Medicine and Global Health)
Buiteman-Kruizinga, Laura A. (Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands)
Carcò, Francesco (IRCCS San Raffaele Scientific Institute (Milà, Itàlia). Department of Anesthesia and Intensive Care)
Chesney, Gregg (Division of Emergency Medicine-Critical Care, Department of Emergency Medicine, NYU Grossman School of Medicine, New York)
Chu, Cindy (University of Oxford. Centre for Tropical Medicine and Global Health)
Dark, Paul (Humanitarian and Conflict Response Institute, University of Manchester)
Dondorp, Arjen M. (Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand)
Gijsbers, Harm J. H. (Department of Rehabilitation Medicine, Amsterdam University Medical Centers)
Gilder, Mary Ellen (Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand)
Grieco, Domenico L. (Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy)
Inglis, Rebecca (Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, University of Oxford, Vientiane, Lao People's Democratic Republic)
Laffey, John (School of Medicine, Disciplines of Anaesthesia and Intensive Care Medicine, National University of Ireland, Galway, Ireland)
Landoni, Giovanni (Vita-Salute San Raffaele University (Milà, Itàlia))
Lu, Weihua (Department of Critical Care Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, China)
Maduro, Lisa M. N. (Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands)
McGready, Rose (University of Oxford. Centre for Tropical Medicine and Global Health)
McNicholas, Bairbre (Department of Anaesthesia and Intensive Care, MedicineGalway University Hospitals, Galway, Ireland)
de Mendoza, Diego (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias)
Morales-Quinteros, Luis (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Nosten, Francois (University of Oxford. Centre for Tropical Medicine and Global Health)
Papali, Alfred (School of Medicine, University of Maryland, Baltimore, Maryland)
Paternoster, Gianluca (Department of Cardiovascular Anaesthesia and ICU, San Carlo Hospital, Potenza, Italy)
Paulus, Frederique (Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Science, Amsterdam, The Netherlands)
Pisani, Luigi (Section of Operational Research, Doctors with Africa CUAMM, Padova, Italy)
Prud'homme, Eloi (Intensive Care Unit, Détresse Respiratoire Infections Sévères, Assistance Publique Hôpitaux de Marseille, Marseille, France)
Ricard, Jean-Damien (Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique - Hôpitaux de Paris, Colombes, France)
Roca, Oriol (Hospital Universitari Vall d'Hebron)
Sartini, Chiara (IRCCS San Raffaele Scientific Institute (Milà, Itàlia). Department of Anesthesia and Intensive Care)
Scaravilli, Vittorio (Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan)
Schultz, Marcus J. (Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand)
Sivakorn, Chaisith (Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand)
Spronk, Peter E. (Expertise Center for Intensive Care Rehabilitation Apeldoorn, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands)
Sztajnbok, Jaques (Intensive Care Unit, Instituto de Infectologia Emilio Ribas, São Paulo, Brazil)
Trigui, Youssef (Service des Maladies Respiratoires, Centre Hospitalier D'Aix-en-Provence, Aix-en-Provence, France)
Vollman, Kathleen M. (Clinical Nurse Specialist/Critical Care Consultant, Advancing Nursing LLC, Northville, Michigan)
van der Woude, Margaretha C. E. (Intensive Care Unit, Zuyderland Medisch Centrum, Location 'Heerlen', Heerlen, The Netherlands)

Date:	2021
Abstract:	Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6-12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	The American Journal of Tropical Medicine and Hygiene, Vol. 104 No. 5 (may 2021) , p. 1676-1686, ISSN 1476-1645

DOI: 10.4269/ajtmh.20-1445
PMID: 33705348

11 p, 542.1 KB

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