Servicio de Medicina Física y Rehabilitación and Departamento de Paciente Crítico, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
Master Program in Physical Therapy and Rehabilitation, School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
Respir Care. 2021 Dec;66(12):1898-1911. doi: 10.4187/respcare.09194. Epub 2021 Jul 23.
Prone positioning is a therapy utilized globally to improve gas exchange, minimize ventilator-induced lung injury, and reduce mortality in ARDS, particularly during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Whereas the respiratory benefits of prone positioning in ARDS have been accepted, the concurrent complications could be undervalued. Therefore, this study aimed to identify the adverse events (AEs) related to prone positioning in ARDS and, secondarily, to collect strategies and recommendations to mitigate these AEs.
In this scoping review, we searched recommendation documents and original studies published between June 2013 and November 2020 from 6 relevant electronic databases and the websites of intensive care societies.
We selected 41 documents from 121 eligible documents, comprising 13 recommendation documents and 28 original studies (involving 1,578 subjects and 994 prone maneuvers). We identified > 40 individual AEs, and the highest-pooled occurrence rates were those of severe desaturation (37.9%), barotrauma (30.5%), pressure sores (29.7%), ventilation-associated pneumonia (28.2%), facial edema (16.7%), arrhythmia (15.4%), hypotension (10.2%), and peripheral nerve injuries (8.1%). The reported mitigation strategies during prone positioning included alternate face rotation (18 [43.9%]), repositioning every 2 h (17 [41.5%]), and the use of pillows under the chest and pelvis (14 [34.1%]). The reported mitigation strategies for performing the prone maneuver comprised one person being at the headboard (23 [56.1%]), the use of a pre-maneuver safety checklist (18 [43.9%]), vital sign monitoring (15 [36.6%]), and ensuring appropriate ventilator settings (12 [29.3%]).
We identified > 40 AEs reported in prone positioning ARDS studies, including additional AEs not yet reported by previous systematic reviews. The pooled AE proportions collected in this review could guide research and clinical practice decisions, and the strategies to mitigate AEs could promote future consensus-based recommendations.
俯卧位通气是一种在全球范围内用于改善气体交换、最小化呼吸机相关性肺损伤和降低急性呼吸窘迫综合征（ARDS）死亡率的治疗方法，尤其是在当前的 2019 年冠状病毒病（COVID-19）大流行期间。尽管俯卧位通气对 ARDS 的呼吸益处已被接受，但同时存在的并发症可能被低估了。因此，本研究旨在确定 ARDS 患者俯卧位相关的不良事件（AE），其次是收集减轻这些 AE 的策略和建议。
在本次范围界定综述中，我们从 6 个相关电子数据库和重症监护学会的网站中检索了 2013 年 6 月至 2020 年 11 月期间发表的推荐文件和原始研究。
我们从 121 篇合格文献中选择了 41 篇文献，包括 13 篇推荐文献和 28 篇原始研究（涉及 1578 名患者和 994 次俯卧位操作）。我们确定了 >40 种个体 AE，发生率最高的是严重低氧血症（37.9%）、气压伤（30.5%）、压疮（29.7%）、呼吸机相关性肺炎（28.2%）、面部水肿（16.7%）、心律失常（15.4%）、低血压（10.2%）和周围神经损伤（8.1%）。俯卧位通气时报告的缓解策略包括交替面部旋转（18 [43.9%]）、每 2 小时重新定位（17 [41.5%]）和在胸部和骨盆下放置枕头（14 [34.1%]）。俯卧位操作的报告缓解策略包括一个人在床头（23 [56.1%]）、使用操作前安全检查表（18 [43.9%]）、生命体征监测（15 [36.6%]）和确保适当的呼吸机设置（12 [29.3%]）。
我们确定了在 ARDS 患者俯卧位通气研究中报告的 >40 种 AE，包括以前系统评价未报告的其他 AE。本综述中收集的 AE 比例可指导研究和临床实践决策，减轻 AE 的策略可促进未来基于共识的建议。
