Awake prone positioning in acute hypoxaemic respiratory failure
McNicholas, Bairbre A. (University of Galway)
Ibarra-Estrada, Miguel (Hospital Civil Fray Antonio Alcalde)
Perez, Yonatan (Hôpitaux universitaires de Strasbourg)
Li, Jie (Rush University)
Pavlov, Ivan (Hôpital de Verdun)
Kharat, Aileen (Geneva University Hospitals)
Vines, David L. (Rush University)
Roca, Oriol (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Cosgrave, David (University of Galway)
Guérin, Claude (University of Lyon)
Ehrmann, Stephan (Médecine Intensive Réanimation)
Laffey, John (University of Galway)
Universitat Autònoma de Barcelona

Date:	2023
Abstract:	Awake prone positioning (APP) of patients with acute hypoxaemic respiratory failure gained considerable attention during the early phases of the coronavirus disease 2019 (COVID-19) pandemic. Prior to the pandemic, reports of APP were limited to case series in patients with influenza and in immunocompromised patients, with encouraging results in terms of tolerance and oxygenation improvement. Prone positioning of awake patients with acute hypoxaemic respiratory failure appears to result in many of the same physiological changes improving oxygenation seen in invasively ventilated patients with moderate-severe acute respiratory distress syndrome. A number of randomised controlled studies published on patients with varying severity of COVID-19 have reported apparently contrasting outcomes. However, there is consistent evidence that more hypoxaemic patients requiring advanced respiratory support, who are managed in higher care environments and who can be prone for several hours, benefit most from APP use. We review the physiological basis by which prone positioning results in changes in lung mechanics and gas exchange and summarise the latest evidence base for APP primarily in COVID-19. We examine the key factors that influence the success of APP, the optimal target populations for APP and the key unknowns that will shape future research. Awake prone positioning of patients with acute hypoxaemic respiratory failure reduces invasive ventilation risk in patients requiring advanced respiratory support, who are managed in higher care environments and who can be prone for several hours.
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, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	European Respiratory Review, Vol. 32 (may 2023) , ISSN 1600-0617

DOI: 10.1183/16000617.0245-2022
PMID: 37137508

17 p, 1.2 MB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Articles > Research articles
Articles > Published articles