Qadri Syeda Kashfi, Ng Priscilla, Toh Theresa Shu Wen, Loh Sin Wee, Tan Herng Lee, Lin Cheryl Bin, Fan Eddy, Lee Jan Hau
Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
Pulm Ther. 2020 Dec;6(2):233-246. doi: 10.1007/s41030-020-00135-4. Epub 2020 Oct 21.
Prone position is known to improve mortality in patients with acute respiratory distress syndrome (ARDS). The impact of prone position in critically ill patients with coronavirus disease of 2019 (COVID-19) remains to be determined. In this review, we describe the mechanisms of action of prone position, systematically appraise the current experience of prone position in COVID-19 patients, and highlight unique considerations for prone position practices during this pandemic.
For our systematic review, we searched PubMed, Scopus and EMBASE from January 1, 2020, to April 16, 2020. After completion of our search, we became aware of four relevant publications during article preparation that were published in May and June 2020, and these studies were reviewed for eligibility and inclusion. We included all studies reporting clinical characteristics of patients admitted to the hospital with COVID-19 disease who received respiratory support with high-flow nasal cannula, or noninvasive or mechanical ventilation and reported the use of prone position. The full text of eligible articles was reviewed, and data regarding study design, patient characteristics, interventions and outcomes were extracted.
We found seven studies (total 1899 patients) describing prone position in COVID-19. Prone position has been increasingly used in non-intubated patients with COVID-19; studies show high tolerance and improvement in oxygenation and lung recruitment. Published studies lacked a description of important clinical outcomes (e.g., mortality, duration of mechanical ventilation).
Based on the findings of our review, we recommend prone position in patients with moderate to severe COVID-19 ARDS as per existing guidelines. A trial of prone position should be considered for non-intubated COVID-19 patients with hypoxemic respiratory failure, as long as this does not result in a delay in intubation.
已知俯卧位可改善急性呼吸窘迫综合征（ARDS）患者的死亡率。俯卧位对2019冠状病毒病（COVID-19）危重症患者的影响尚待确定。在本综述中，我们描述了俯卧位的作用机制，系统评估了COVID-19患者俯卧位的当前经验，并强调了在此次疫情期间俯卧位操作的独特注意事项。
对于我们的系统综述，我们检索了2020年1月1日至2020年4月16日的PubMed、Scopus和EMBASE。在检索完成后，我们在文章撰写过程中了解到2020年5月和6月发表的4篇相关出版物，并对这些研究进行了资格审查和纳入评估。我们纳入了所有报告COVID-19疾病住院患者临床特征的研究，这些患者接受了高流量鼻导管呼吸支持、无创或机械通气，并报告了俯卧位的使用情况。对符合条件的文章全文进行了审查，并提取了有关研究设计、患者特征、干预措施和结果的数据。
我们发现7项研究（共1899例患者）描述了COVID-19患者的俯卧位情况。俯卧位在未插管的COVID-19患者中使用越来越多；研究表明耐受性良好，氧合和肺复张情况有所改善。已发表的研究缺乏对重要临床结局（如死亡率、机械通气时间）的描述。
基于我们综述的结果，我们建议根据现有指南，对中度至重度COVID-19 ARDS患者采用俯卧位。对于低氧性呼吸衰竭的未插管COVID-19患者，只要不导致插管延迟，就应考虑试行俯卧位。
