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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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01-04-2021 | Acute Respiratory Distress-Syndrome | Special Article

Prone positioning for ARDS patients—tips for preparation and use during the COVID-19 pandemic

Authors: Ken Kuljit S. Parhar, MD, MSc, Danny J. Zuege, MD, MSc, Karen Shariff, MN, Gwen Knight, MA, Sean M. Bagshaw, MD, MSc

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 4/2021

Abstract

Many patients with coronavirus disease (COVID-19) will develop acute respiratory distress syndrome (ARDS). Prone positioning is an important non-pharmacologic strategy that should be considered for all invasively ventilated patients with moderate to severe ARDS (including those with COVID-19). Prone positioning offers several physiologic and clinical benefits, including improving hypoxemia, matching ventilation with perfusion, reducing regional hyperinflation, and improving survival. To safely offer prone positioning, appropriate training, simulation, and health system planning should be undertaken. In this review, we offer ten tips, based on the Alberta provincial prone positioning strategy during COVID-19, to safely implement and improve the appropriate use of prone positioning. We provide special considerations for its use during the COVID-19 pandemic or future respiratory pandemics.

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Kallet RH. A comprehensive review of prone position in ARDS. Respir Care 2015; 60: 1660-87.CrossRefPubMed

Scholten EL, Beitler JR, Prisk GK, Malhotra A. Treatment of ARDS with prone positioning. Chest 2017; 151: 215-24.CrossRefPubMed

Gattinoni L, Busana M, Giosa L, Macri MM, Quintel M. Prone positioning in acute respiratory distress syndrome. Semin Respir Crit Care Med 2019; 40: 94-100.CrossRefPubMed

Chiumello D, Brochard L, Marini JJ, et al. Respiratory support in patients with acute respiratory distress syndrome: an expert opinion. Crit Care 2017; DOI: https://doi.org/10.1186/s13054-017-1820-0.CrossRefPubMedPubMedCentral

Fan E, Del Sorbo L, Goligher EC, et al. An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2017; 195: 1253-63.CrossRefPubMed

World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance, 28 January 2020. Available from URL: https://apps.who.int/iris/handle/10665/330893 (accessed October 2020).

Guerin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368: 2159-68.CrossRefPubMed

Munshi L, Del Sorbo L, Adhikari NK, et al. Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Ann Am Thorac Soc 2017; 14(Supplement_4): S280-8.

Samanta S, Samanta S, Wig J, Baronia AK. How safe is the prone position in acute respiratory distress syndrome at late pregnancy? Am J Emerg Med 2014; 32(687): e1-3.

10.

Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G. Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med 2001; 29: 1955-61.CrossRefPubMed

11.

Guerin C, Beuret P, Constantin JM, 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.CrossRefPubMed

12.

Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in critically ill patients in the Seattle region - case series. N Engl J Med 2020; 382: 2012-22.CrossRefPubMed

13.

Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 Admitted to ICUs of the Lombardy region. Italy. JAMA 2020; 323: 1574-81.CrossRefPubMed

14.

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: 475-81.CrossRefPubMedPubMedCentral

15.

Mazer SP, Weisfeldt M, Bai D, et al. Reverse CPR: a pilot study of CPR in the prone position. Resuscitation 2003; 57: 279-85.CrossRefPubMed

Title: Prone positioning for ARDS patients—tips for preparation and use during the COVID-19 pandemic
Authors: Ken Kuljit S. Parhar, MD, MSc
Danny J. Zuege, MD, MSc
Karen Shariff, MN
Gwen Knight, MA
Sean M. Bagshaw, MD, MSc
Publication date: 01-04-2021
Publisher: Springer International Publishing
Keywords: Acute Respiratory Distress-Syndrome
COVID-19
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 4/2021
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-020-01885-0

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Prone positioning for ARDS patients—tips for preparation and use during the COVID-19 pandemic

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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