prone position
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Introduction
Lying on the abdomen or stomach (face down).
Indications
- sleeping in prone position lowers systolic blood pressure in men as much as 15 mm Hg[2]
- prone positioning may help to aerate lung regions dependent in a supine position during mechanical ventilation in patients with ARDS[3]
- prone positioning may help COVID-19 patients who require oxygen improve oxygenation & avoid intubation[6][7][9]
- prone positioning in mildly hypoxemic hospitalized Covid-19 patients requiring oxygen of no benefit possibly because of low adherence[10][11]
- prone positioning in awake Covid-19 patients requring oxygen
- reduces intubation risk & hospital stay[12]
- not beneficial[13]; benefit not comfirmed, but could not be excluded[14]
Procedure
- minimum suggested duration of prone position is 12 hours a day[5]
Mechanism of action
- recruitment in dorsal lung regions[5]
- increasing end-expiratory lung volume
- increasing chest wall elastane
- decreasing alveolar shunt
- improving tidal volume
- improves ventilation-perfusion mismatch[8]
- prone position can only reduce mortality due to ARDS when patients are
- ventilated with low tidal volume
- started within 48 hours
- patients have severe hypoxia[5]
Additional terms
References
- ↑ Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ 2.0 2.1 Tabara Y, American Heart Association Conference, Chicago, 2004
- ↑ 3.0 3.1 Guerin C et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013 Jun 6; 368:2159 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23688302 Free Article
- ↑ Caputo N, Strayer RJ, Levitan R Early Self-Proning in Awake Non-intubated Patients in the Emergency Department: A single ED;s Experimen during the COVID-19 Pandemic. Academic Emergency Medicine. April 22 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32320506 https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.13994
- ↑ 5.0 5.1 5.2 5.3 Ghelichkhani P, Esmaeili M. Prone Position in Management of COVID-19 Patients; a Commentary. Arch Acad Emerg Med. 2020 Apr 11;8(1):e48. eCollection 2020. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32309812 Free PMC Article
- ↑ 6.0 6.1 Davenport L COVID-19: Jury Out Over Prone Position in Nonintubated Patients. Medscape - May 22, 2020. https://www.medscape.com/viewarticle/931029
- ↑ 7.0 7.1 Elharrar X, Trigui Y, Dols AM et al. Use of prone positioning in nonintubated patients with COVID-19 and hypoxemic acute respiratory failure. JAMA 2020 May 15; PMID: https://www.ncbi.nlm.nih.gov/pubmed/32412581 Free PMC article. https://jamanetwork.com/journals/jama/fullarticle/2766292
Sartini C, Tresoldi M, Scarpellini P et al. Respiratory parameters in patients with COVID-19 after using noninvasive ventilation in the prone position outside the intensive care unit. JAMA 2020 May 15; PMID: https://www.ncbi.nlm.nih.gov/pubmed/32412606 Free PMC article. https://jamanetwork.com/journals/jama/fullarticle/2766291 - ↑ 8.0 8.1 Thompson AE, Ranard BL, Wei Y et al Prone Positioning in Awake, Nonintubated Patients With COVID-19 Hypoxemic Respiratory Failure. JAMA Intern Med. Published online June 17, 2020. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32584946 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2767575
Sarma A, Calfee CS Prone Positioning in Awake, Nonintubated Patients With COVID-19. Necessity Is the Mother of Invention. JAMA Intern Med. Published online June 17, 2020. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32584940 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2767574 - ↑ 9.0 9.1 Reuters Staff Prone Positioning Might Help More COVID-19 Patients Medscape - Nov 20, 2020 https://www.medscape.com/viewarticle/941334
Venus K, Munshi L, Fralick M. Prone positioning for patients with hypoxic respiratory failure related to COVID-19. CMAJ 2020, Nov 11 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33177104 Free article https://www.cmaj.ca/content/cmaj/early/2020/11/11/cmaj.201201.full.pdf - ↑ 10.0 10.1 Fralick M et al. Prone positioning of patients with moderate hypoxaemia due to covid-19: Multicentre pragmatic randomised trial (COVID-PRONE). BMJ 2022 Mar 23; 376:e068585 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35321918 PMCID: PMC8941343 Free PMC article https://www.bmj.com/content/376/bmj-2021-068585
- ↑ 11.0 11.1 Johnson SA et al Patient-directed Prone Positioning in Awake Patients with COVID-19 Requiring Hospitalization (PAPR). Ann Am Thorac Soc. 2021 Aug;18(8):1424-1426 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33596394 PMCID: PMC8513661 Free PMC article https://www.atsjournals.org/doi/10.1513/AnnalsATS.202011-1466RL
- ↑ 12.0 12.1 Ibarra-estrada M, Vargas-Obieta A, Marin-Rosales M et al 19: PRONE POSITIONING IN AWAKE PATIENTS WITH COVID-19-ASSOCIATED RESPIRATORY FAILURE: THE PROCARF TRIAL. Critical Care Medicine: January 2022 - Volume 50 - Issue 1 - p 10 https://journals.lww.com/ccmjournal/Fulltext/2022/01001/19__PRONE_POSITIONING_IN_AWAKE_PATIENTS_WITH.21.aspx
Ibarra-Estrada M, Li J, Pavlov I et al Factors for success of awake prone positioning in patients with COVID-19-induced acute hypoxemic respiratory failure: analysis of a randomized controlled trial. Crit Care. 2022 Mar 28;26(1):84 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35346319 PMCID: PMC8958810 Free PMC article - ↑ 13.0 13.1 Qian ET et al. Assessment of awake prone positioning in hospitalized adults with COVID-19: A nonrandomized controlled trial. JAMA Intern Med 2022 Jun; 182:612. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35435937 PMCID: PMC9016608 Free PMC article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2791385
- ↑ 14.0 14.1 Alhazzani W et al. Effect of awake prone positioning on endotracheal intubation in patients with COVID-19 and acute respiratory failure: A randomized clinical trial. JAMA 2022 Jun 7; 327:2104-2113 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35569448 PMCID: PMC9108999 Free PMC article https://jamanetwork.com/journals/jama/fullarticle/2792506