Karpov Andrei, Mitra Anish R, Crowe Sarah, Haljan Gregory
Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
Crit Care Res Pract. 2020 Nov 12;2020:6688120. doi: 10.1155/2020/6688120. eCollection 2020.
This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. . This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. . We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team.
The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.
这是一项回顾性病例系列研究，描述了在新冠疫情期间三级重症监护病房中拔管后俯卧位通气（PEPP）的可行性、耐受性及其对生理参数的影响。本研究针对新冠疫情期间在萨里纪念医院三级重症监护病房住院的新冠呼吸衰竭患者开展。我们在文献中未发现关于长时间插管后进行PEPP的先前报道。4例患者在脱离长时间机械通气后共接受了13次PEPP治疗。每位患者接受俯卧位治疗的中位数为3次（四分位间距：2，4.25），每次持续时间中位数为1.5小时（四分位间距：1.2，2.1）。PEPP治疗与氧需求中位数、患者呼吸频率及再次插管率的降低相关。患者、护理人员及联合健康团队对这些治疗的耐受性良好。
新冠呼吸衰竭患者在脱离长时间机械通气后进行PEPP这一创新做法是可行的且耐受性良好，可能与包括改善氧合和呼吸频率以及低再次插管率在内的良好临床结局相关。有必要对PEPP开展更大规模的前瞻性研究。
