Adeola Janet O, Patel Shivani, Goné Evelyne N, Tewfik George
Department of Anesthesia and Perioperative Care, Rutgers New Jersey Medical School, Newark, NJ, USA.
Clin Med Insights Circ Respir Pulm Med. 2021 Jul 1;15:11795484211028526. doi: 10.1177/11795484211028526. eCollection 2021.
The purpose of this review is to highlight the multisystem effects of prone position in ARDS patients with a focus on current findings regarding its use in COVID-19 patients.
Two reviewers comprehensively searched PubMed database for literature regarding pathophysiology and efficacy of prone position in ARDS patients as well as specific data regarding this approach in COVID-19 patients.
Prone positioning is well-documented to improve oxygenation and cardiac function in ARDS patients and might confer increased survival, with benefits that outweigh risks such as facial edema, endotracheal tube displacement, and intraabdominal organ dysfunction in obese patients. Severe COVID-19 pneumonia, while meeting ARDS criteria, differs from typical ARDS in several ways. Data would suggest that advantages of prone position would become limited after significant disease progression and fibrosis. The use of this technique in COVID-19 requires prolonged sessions that are unprecedented in the treatment of ARDS patients. New data regarding COVID-19 pathophysiology and patients continues to evolve daily. More frequently, patients are proned while maintaining spontaneous breathing-the results of this intervention are an area for future studies. There is more to learn about the appropriate use of prone position in COVID-19 patients. The multisystem risks and benefits require clinicians to adopt a patient centered decision-making algorithm when employing this technique in COVID-19 patients.
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本综述旨在强调俯卧位对急性呼吸窘迫综合征（ARDS）患者的多系统影响，重点关注其在新型冠状病毒肺炎（COVID-19）患者中应用的当前研究结果。
两名综述作者全面检索了PubMed数据库，以获取有关ARDS患者俯卧位病理生理学和疗效的文献，以及该方法在COVID-19患者中的具体数据。
有充分文献证明，俯卧位可改善ARDS患者的氧合和心功能，并可能提高生存率，其益处超过面部水肿、气管插管移位和肥胖患者腹腔内器官功能障碍等风险。重度COVID-19肺炎虽符合ARDS标准，但在几个方面与典型ARDS不同。数据表明，在疾病显著进展和纤维化后，俯卧位的优势将变得有限。在COVID-19中使用该技术需要较长时间，这在ARDS患者治疗中是前所未有的。关于COVID-19病理生理学和患者的新数据每天都在不断变化。更常见的是，患者在保持自主呼吸的同时采用俯卧位——这种干预的结果是未来研究的一个领域。关于在COVID-19患者中正确使用俯卧位还有更多需要了解的地方。多系统风险和益处要求临床医生在COVID-19患者中采用该技术时，采用以患者为中心的决策算法。
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