Acta Scientific Medical Sciences (ASMS)(ISSN: 2582-0931)

Research Article Volume 5 Issue 12

Effect of Pronation and Postural Changes on Non-intubated Patients with Respiratory Failure Due to Covid-19 Interstitial Pneumonia

Lorenzo Porta1,2*, Giulio Cassano1,2, Silvia Gheda1,2, Adriano Basile1 and Andrea Bellone1

1Emergency Medicine Department, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
2University of Milan-Bicocca, School of Medicine and Surgery, Monza, Italy

*Corresponding Author: Lorenzo Porta, Emergency Medicine Department, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.

Received: October 05, 2021; Published: November 17, 2021

Abstract

Background: There is still paucity of data regarding pronation on non-intubated patients with respiratory failure due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2).

Objective: To evaluate the effects of prone and lateral positioning on acute respiratory failure (ARF) due to SARS-CoV-2 interstitial pneumonia.

Methods: We retrospectively analyzed data of all patients admitted to our medical ward from the 1st of March to the 15th of April 2020 with acute respiratory failure due to SARS-CoV-2 pneumonia. We compared patients mobilized in either lateral or prone positions with those mobilized just in sitting position. We recorded data on postural changes and all possible confounding variables. We assessed the relationship between postural changes and necessity of endotracheal intubation (ETI), obtaining crude and adjusted Odds Ratios (ORs), using conditional logistic regression analysis. Furthermore, we analyzed mortality for DNI (do not intubate) and actual intubation for non DNI, respectively.

Results: Our population of 98 patients had a male/female ratio of 3.25, a mean age of 65,6 years, a mean P/F of 183,3 and a median APACHE II score of 9. Crude and adjusted ORs with Confidence Interval (CI) for the need of ETI were 0,239 (CI95, 0,102-0,556, p 0,001) and 0,045 (CI95, 0,008-0,244, p < 0,001). Crude and adjusted ORs for ETI in the non-DNI population were 0,137 (CI95, 0,044-0,422, p 0,001) and 0,076 (CI95, 0,014-0,404, p 0,002), respectively. The OR for mortality in the DNI subgroup did not achieve statistical significance, even after adjustment. Compared to the sitting position, prone and lateral positions were associated with higher improvement in mean SpO2 (+5.25% and +4.50%, respectively), with a partial benefit persistent after resupination (+3.68% and +1.87%, respectively).

Conclusions: Our study claims that the systematical application of prone and/or lateral positions can reduce ETI in SARS-CoV-2 patients with mild to severe ARF, due to a beneficial effect on SpO2 and, thus, tissue hypoxia.

Keywords: Prone Positioning; SARS-CoV-2; Interstitial Pneumonia; Prone Ventilation; Acute Respiratory Failure; Non-intubated Patients

References

  1. Guan WJ., et al. “Clinical characteristics of 2019 novel coronavirus infection in China”. New England Journal of Medicine 382 (2020): 1708-1720.
  2. Shi H., et al. “Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study”. Lancet Infectious Diseases 20 (2020): 425.
  3. Zhao W., et al. “Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study”. The American Journal of Roentgenology (2020): 1.
  4. Wang D., et al. “Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China”. The Journal of the American Medical Association 11 (2020): 1061-1069.
  5. Chen N., et al. “Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study”. Lancet 395 (2020): 507-513.
  6. Huang C., et al. “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. Lancet 395 (2020): 497-506.
  7. Wu C., et al. “Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China”. The Journal of the American Medical Association Internal Medicine 7 (2020): 934-943.
  8. Guérin C., et al. “Prone positioning in severe acute respiratory distress syndrome”. The New England Journal of Medicine 368 (2013): 2159-68.
  9. Pan C., et al. “Lung Recruitability in SARS-CoV-2 Associated Acute Respiratory Distress Syndrome: A Single-center, Observational Study”. American Journal of Respiratory and Critical Care Medicine (2020).
  10. Alhazzani W., et al. “Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)”. Intensive Care Medicine 46(2020):854-887.
  11. Lazzeri M., et al. “Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR)”. Monaldi Archives for Chest Disease1 (2020).
  12. Gattinoni L., et al. “Prone positioning in acute respiratory failure”. In: Tobin MJ editor(s). Principles and Practice of Mechanical Ventilation. 2nd Edition. New York: McGraw-Hill Education (2006): 1081-1092.
  13. Guerin C. “Ventilation in the prone position in patients with acute lung injury/acute respiratory distress syndrome”. Current Opinion in Critical Care 12 (2006): 50-54.
  14. Graf J and Marini JJ. “Do airway secretions play an underappreciated role in acute respiratory distress syndrome?” Current Opinion in Critical Care 14 (2008): 44-49.
  15. Marini JJ. “Can we prevent the spread of focal lung inflammation”? Critical Care Medicine 38 (2010): 574-581.
  16. Gattinoni L., et al. “Stress and strain within the lung”. Current Opinion in Critical Care 1 (2012): 42-47.
  17. Gattinoni L., et al. “Prone position in acute respiratory distress syndrome: rationale, indications, and limits”. American Journal of Respiratory Critical Care Medicine 11 (2013): 1286-1293.
  18. Mentzelopoulos SD., et al. “Prone position reduces lung stress in severe acute respiratory distress syndrome”. European Respiratory Journal 25 (2005): 534-544.
  19. Pelosi P., et al. “Prone position in acute respiratory distress syndrome”. European Respiratory Journal 20 (2020): 1017.
  20. Chatte G., et al. “Prone position in mechanically ventilated patients with severe acute respiratory failure”. American Journal of Respiratory and Critical Care Medicine 155 (1997): 473.
  21. Fridrich P., et al. “The effects of long-term prone positioning in patients with trauma-induced adult respiratory distress syndrome”. Anesthesia and Analgesia 83 (1996): 1206.
  22. Taccone P., et al. “Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial”. The Journal of the American Medical Association 302 (2009): 1977.
  23. Guerin C., et al. “Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial”. The Journal of the American Medical Association 292 (2004): 2379.
  24. Gattinoni L., et al. “Effect of prone positioning on the survival of patients with acute respiratory failure”. The New England Journal of Medicine 345 (2001): 568.
  25. Mancebo J., et al. “A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome”. American Journal of Respiratory and Critical Care Medicine 173 (2006): 1233.
  26. Lee JM., et al. “The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome” updated study-level meta-analysis of 11 randomized controlled trials. Critical Care Medicine 42 (2014): 1252.
  27. Bloomfield R., et al. “Prone position for acute respiratory failure in adults”. Cochrane Database Systematic Reviews (2015): CD008095.
  28. Munshi L., et al. “Prone Position for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis”. Annals of the American Thoracic Society 14 (2017): S280.
  29. Valter C., et al. “Response to the prone position in spontaneously breathing patients with hypoxemic respiratory failure”. Acta Anaesthesiologica Scandinavica 47 (2003): 416-8.
  30. Feltracco P., et al. “Non-invasive ventilation in prone position for refractory hypoxemia after bilateral lung transplantation”. Clinical Transplant 23 (2009): 748-50.
  31. Scaravilli V., et al. “Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure”. A retrospective study, Journal of Critical Care (2015): 1390-1394.
  32. Grasselli G., et al. “Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response”. The Journal of the American Medical Association (2020).
  33. Ferrer M., et al. “Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial”. American Journal of Respiratory and Critical Care Medicine 168 (2003): 1438-1444.
  34. Plant PK., et al. “Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial”. Lancet 355 (2000): 1931-1935.
  35. Brambilla AM., et al. “Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia” [published correction appears in Intensive Care Medicine. Intensive Care Medicine7 (2014): 942‐949.
  36. Ding, L., et al. “Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-center prospective cohort study”. Critical Care 24 (2020): 28.
  37. Marini JJ and Gattinoni L. “Management of COVID-19 Respiratory Distress”. The Journal of the American Medical Association (2020).
  38. Gattinoni L., et al. “COVID-19 pneumonia: different respiratory treatments for different phenotypes?” Intensive Care Medicine6 (2020): 1099-1102.

Citation

Citation: Lorenzo Porta., et al. “Effect of Pronation and Postural Changes on Non-intubated Patients with Respiratory Failure Due to Covid-19 Interstitial Pneumonia”.Acta Scientific Medical Sciences 5.12 (2021): 94-103.

Copyright

Copyright: © 2021 Lorenzo Porta., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate30%
Acceptance to publication20-30 days
Impact Factor1.111

Indexed In





News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is January 15, 2022.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US