1. Home
  2. Vol 9, No 1 (2024)
  3. Tan

Effectiveness of Awake Prone Position in Non-Intubated ARDS Patients: A Literature Review

Julianus Yudhistira Tan(1), Cecep Eli Kosasih(2), Henny Suzana Mediani(3*)
(1) Universitas Padjadjaran (UNPAD)
(2) Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Indonesia
(3) Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Indonesia
(*) Corresponding Author
DOI : 10.30604/jika.v9i1.2664

Abstract

Background: The prone position is one of the highly recommended interventions to treat hypoxaemia and lung injury in ARDS patients. However, its efficacy in non-intubated patients remains inconclusive due to predominantly being reviewed through observational and case studies. This review aims to evaluate the efficacy of prone position on the oxygenation status and mortality rate of ARDS patients through experimental studies. Methode: This review systematically searched three international databases: PubMed, Web of Science, and CINAHL from November to December 2022, without restricting the publication year. The focus was solely on experimental studies examining the effectiveness of prone positioning in adult, non-intubated ARDS patients. The quality of studies was assessed using the JBI critical appraisal tool. Results: Of the 12 included studies, most RCTs were identified as poor quality. All patients appeared to be infected with Covid-19, and the majority were on conventional oxygen therapy. Most studies showed that the prone position was effective in improving the oxygenation status for up to two hours post-session, with a mortality rate not substantially different from that of control group. Further good-quality experimental studies are needed to strengthen these results. Conclusion: The prone position is quite effective in improving the oxygenation status of patients.

Keywords


Prone position; ARDS; Oxygenation; Covid-19

References


Aeen, F. B., Pakzad, R., Rad, M. G., Abdi, F., Zaheri, F., & Mirzadeh, N. (2021). Effect of prone position on respiratory parameters, intubation and death rate in COVID-19 patients: systematic review and meta-analysis. Scientific Reports, 11(1), 14407. https://doi.org/10.1038/s41598-021-93739-y

Albert, R. K., & Hubmayr, R. D. (2000). The prone position eliminates compression of the lungs by the heart. American Journal of Respiratory and Critical Care Medicine, 161(5), 1660–1665. https://doi.org/10.1164/ajrccm.161.5.9901037

Anand, S., Baishya, M., Singh, A., & Khanna, P. (2021). Effect of awake prone positioning in COVID-19 patients- A systematic review. Trends in Anaesthesia and Critical Care, 36, 17–22. https://doi.org/10.1016/j.tacc.2020.09.008

Bos, L. D. J., & Ware, L. B. (2022). Acute respiratory distress syndrome: Causes, pathophysiology, and phenotypes. The Lancet, 400(10358), 1145–1156. https://doi.org/10.1016/S0140-6736(22)01485-4

Camporota, L., Sanderson, B., Chiumello, D., Terzi, N., Argaud, L., Rimmelé, T., Metuor, R., Verstraete, A., Cour, M., Bohé, J., Piriou, V., Beuret, P., & Guérin, C. (2022). Prone Position in COVID-19 and COVID-19 Acute Respiratory Distress Syndrome: An International Multicenter Observational Comparative Study. Critical Care Medicine, 50(4), 633–643. https://doi.org/10.1097/CCM.0000000000005354

Chilkoti, G. T., Mohta, M., Ahmad, Z., & Saxena, A. K. (2022). Awake Prone-Positioning in Patients on Non-Invasive Ventilation for Management of SARS-CoV-2 Pneumonia: A Systematic Review. Advances in Respiratory Medicine, 90(4), 362–375. https://doi.org/10.3390/arm90040046

Chiumello, D., Chiodaroli, E., Coppola, S., Cappio Borlino, S., Granata, C., Pitimada, M., & Wendel Garcia, P. D. (2021). Awake prone position reduces work of breathing in patients with COVID-19 ARDS supported by CPAP. Annals of Intensive Care, 11(1), 179. https://doi.org/10.1186/s13613-021-00967-6

Cochi, S. E., Kempker, J. A., Annangi, S., Kramer, M. R., & Martin, G. S. (2016). Mortality trends of acute respiratory distress syndrome in the United States from 1999-2013. Annals of the American Thoracic Society, AnnalsATS.201512-841OC. https://doi.org/10.1513/AnnalsATS.201512-841OC

Cornejo, R. A., Díaz, J. C., Tobar, E. A., Bruhn, A. R., Ramos, C. A., González, R. A., Repetto, C. A., Romero, C. M., Gálvez, L. R., Llanos, O., Arellano, D. H., Neira, W. R., Díaz, G. A., Zamorano, A. J., & Pereira, G. L. (2013). Effects of prone positioning on lung protection in patients with acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 188(4), 440–448. https://doi.org/10.1164/rccm.201207-1279OC

Cruz, R. S., Irrazábal, C., Gonzalez, L., Geloso, A., Nuñez, C., & Cornejo, R. (2022). Analytic review and meta-analysis of awake prone positioning in patients with Covid-19. Medicina Intensiva, 46(10), 580–582. https://doi.org/10.1016/j.medin.2021.11.003

Ehrmann, S., Li, J., Ibarra-Estrada, M., Perez, Y., Pavlov, I., McNicholas, B., Roca, O., Mirza, S., Vines, D., Garcia-Salcido, R., Aguirre-Avalos, G., Trump, M. W., Nay, M.-A., Dellamonica, J., Nseir, S., Mogri, I., Cosgrave, D., Jayaraman, D., Masclans, J. R., … Kimmoun, A. (2021). Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. The Lancet Respiratory Medicine, 9(12), 1387–1395. https://doi.org/10.1016/S2213-2600(21)00356-8

Eworuke, E., Major, J. M., & Gilbert McClain, L. I. (2018). National incidence rates for Acute Respiratory Distress Syndrome (ARDS) and ARDS cause-specific factors in the United States (2006–2014). Journal of Critical Care, 47, 192–197. https://doi.org/10.1016/j.jcrc.2018.07.002

Fan, E., Del Sorbo, L., Goligher, E. C., Hodgson, C. L., Munshi, L., Walkey, A. J., Adhikari, N. K. J., Amato, M. B. P., Branson, R., Brower, R. G., Ferguson, N. D., Gajic, O., Gattinoni, L., Hess, D., Mancebo, J., Meade, M. O., McAuley, D. F., Pesenti, A., Ranieri, V. M., … Brochard, L. J. (2017). An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical ventilation in adult patients with acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 195(9), 1253–1263. https://doi.org/10.1164/rccm.201703-0548ST

Fralick, M., Colacci, M., Munshi, L., Venus, K., Fidler, L., Hussein, H., Britto, K., Fowler, R., da Costa, B. R., Dhalla, I., Dunbar-Yaffe, R., Branfield Day, L., MacMillan, T. E., Zipursky, J., Carpenter, T., Tang, T., Cooke, A., Hensel, R., Bregger, M., … Verma, A. A. (2022). Prone positioning of patients with moderate hypoxaemia due to covid-19: multicentre pragmatic randomised trial (COVID-PRONE). BMJ, 376, e068585. https://doi.org/10.1136/bmj-2021-068585

Gad, G. S. (2021). Awake prone positioning versus non invasive ventilation for COVID-19 patients with acute hypoxemic respiratory failure. Egyptian Journal of Anaesthesia, 37(1), 85–90. https://doi.org/10.1080/11101849.2021.1889944

Glenny, R. W., Lamm, W. J. E., Albert, R. K., & Robertson, H. T. (1991). Gravity is a minor determinant of pulmonary blood flow distribution. Journal of Applied Physiology, 71(2), 620–629. https://doi.org/10.1152/jappl.1991.71.2.620

Griffiths, M. J. D., McAuley, D. F., Perkins, G. D., Barrett, N., Blackwood, B., Boyle, A., Chee, N., Connolly, B., Dark, P., Finney, S., Salam, A., Silversides, J., Tarmey, N., Wise, M. P., & Baudouin, S. V. (2019). Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respiratory Research, 6(1), e000420. https://doi.org/10.1136/bmjresp-2019-000420

Guérin, C., Albert, R. K., Beitler, J., Gattinoni, L., Jaber, S., Marini, J. J., Munshi, L., Papazian, L., Pesenti, A., Vieillard-Baron, A., & Mancebo, J. (2020). Prone position in ARDS patients: Why, when, how and for whom. Intensive Care Medicine, 46(12), 2385–2396. https://doi.org/10.1007/s00134-020-06306-w

Guérin, C., Reignier, J., Richard, J.-C., Beuret, P., Gacouin, A., Boulain, T., Mercier, E., Badet, M., Mercat, A., Baudin, O., Clavel, M., Chatellier, D., Jaber, S., Rosselli, S., Mancebo, J., Sirodot, M., Hilbert, G., Bengler, C., Richecoeur, J., … Ayzac, L. (2013). Prone positioning in severe acute respiratory distress syndrome. New England Journal of Medicine, 368(23), 2159–2168. https://doi.org/10.1056/NEJMoa1214103

Ibarra-Estrada, M., Li, J., Pavlov, I., Perez, Y., Roca, O., Tavernier, E., McNicholas, B., Vines, D., Marín-Rosales, M., Vargas-Obieta, A., García-Salcido, R., Aguirre-Díaz, S. A., López-Pulgarín, J. A., Chávez-Peña, Q., Mijangos-Méndez, J. C., Aguirre-Avalos, G., Ehrmann, S., & Laffey, J. G. (2022). Factors for success of awake prone positioning in patients with COVID-19-induced acute hypoxemic respiratory failure: analysis of a randomized controlled trial. Critical Care, 26(1), 84. https://doi.org/10.1186/s13054-022-03950-0

Jayakumar, D., Ramachandran, DNB, P., Rabindrarajan, DNB, E., Vijayaraghavan, MD, B. K. T., Ramakrishnan, AB, N., & Venkataraman, AB, R. (2021). Standard care versus awake prone position in adult nonintubated patients with acute hypoxemic respiratory failure secondary to covid-19 infection - a multicenter feasibility randomized controlled trial. Journal of Intensive Care Medicine, 36(8), 918–924. https://doi.org/10.1177/08850666211014480

Kang, H., Gu, X., & Tong, Z. (2022). Effect of Awake Prone Positioning in non-Intubated COVID-19 Patients with Acute Hypoxemic Respiratory Failure: A Systematic Review and Meta-Analysis. Journal of Intensive Care Medicine, 37(11), 1493–1503. https://doi.org/10.1177/08850666221121593

Kharat, A., Dupuis-Lozeron, E., Cantero, C., Marti, C., Grosgurin, O., Lolachi, S., Lador, F., Plojoux, J., Janssens, J.-P., Soccal, P. M., & Adler, D. (2021). Self-proning in COVID-19 patients on low-flow oxygen therapy: a cluster randomised controlled trial. ERJ Open Research, 7(1), 00692–02020. https://doi.org/10.1183/23120541.00692-2020

Koh, Y. (2014). Update in acute respiratory distress syndrome. Journal of Intensive Care, 2(1), 2. https://doi.org/10.1186/2052-0492-2-2

Koulouras, V., Papathanakos, G., Papathanasiou, A., & Nakos, G. (2016). Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. World Journal of Critical Care Medicine, 5(2), 121. https://doi.org/10.5492/wjccm.v5.i2.121

Li, J., Luo, J., Pavlov, I., Perez, Y., Tan, W., Roca, O., Tavernier, E., Kharat, A., McNicholas, B., Ibarra-Estrada, M., Vines, D. L., Bosch, N. A., Rampon, G., Simpson, S. Q., Walkey, A. J., Fralick, M., Verma, A., Razak, F., Harris, T., … Pacheco, A. (2022). Awake prone positioning for non-intubated patients with Covid-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis. The Lancet Respiratory Medicine, 10(6), 573–583. https://doi.org/10.1016/S2213-2600(22)00043-1

Misra, A., Pal, A., & Pawar, R. (2021). Effect of prone positioning on oxygen saturation in COVID-19 patients in Sri Aurobindo Hospital, Indore. Journal of Pharmaceutical Research International, 33(50B), 121–129. https://doi.org/10.9734/jpri/2021/v33i50B33435

Munshi, L., Del Sorbo, L., Adhikari, N. K. J., Hodgson, C. L., Wunsch, H., Meade, M. O., Uleryk, E., Mancebo, J., Pesenti, A., Ranieri, V. M., & Fan, E. (2017). Prone position for Acute Respiratory Distress Syndrome: A systematic review and meta-analysis. Annals of the American Thoracic Society, 14(Supplement_4), S280–S288. https://doi.org/10.1513/AnnalsATS.201704-343OT

Musso, G., Taliano, C., Molinaro, F., Fonti, C., Veliaj, D., Torti, D., Paschetta, E., Castagna, E., Carbone, G., Laudari, L., Aseglio, C., Zocca, E., Chioni, S., Giannone, L. C., Arabia, F., Deiana, C., Benato, F. M., Druetta, M., Campagnola, G., … Tirabassi, G. (2022). Early prolonged prone position in noninvasively ventilated patients with SARS CoV 2 related moderate to severe hypoxemic respiratory failure: clinical outcomes and mechanisms for treatment response in the PRO-NIV study. Critical Care, 26(1), 118. https://doi.org/10.1186/s13054-022-03937-x

Othman, S. Y., El?Menshawy, A. M., & Mohamed, A. M. (2022). Effects of awake?prone positioning on oxygenation and physiological outcomes in non?intubated patients with COVID?19: a randomized controlled trial. Nursing in Critical Care. https://doi.org/10.1111/nicc.12833

Papazian, L., Aubron, C., Brochard, L., Chiche, J.-D., Combes, A., Dreyfuss, D., Forel, J.-M., Guérin, C., Jaber, S., Mekontso-Dessap, A., Mercat, A., Richard, J.-C., Roux, D., Vieillard-Baron, A., & Faure, H. (2019). Formal guidelines: Management of acute respiratory distress syndrome. Annals of Intensive Care, 9(1), 69. https://doi.org/10.1186/s13613-019-0540-9

Patel, V. J., Biswas Roy, S., Mehta, H. J., Joo, M., & Sadikot, R. T. (2018). Alternative and natural therapies for acute lung injury and acute respiratory distress syndrome. BioMed Research International, 2018, 1–9. https://doi.org/10.1155/2018/2476824

Ranieri, V. M., Rubenfeld, G. D., Thompson, B. T., Ferguson, N. D., Caldwell, E., Fan, E., Camporota, L., & Slutsky, A. S. (2012). Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA, 307(23), 2526–2533. https://doi.org/10.1001/jama.2012.5669

Scholten, E. L., Beitler, J. R., Prisk, G. K., & Malhotra, A. (2017). Treatment of ARDS with prone positioning. Chest, 151(1), 215–224. https://doi.org/10.1016/j.chest.2016.06.032

Sryma, P., Mittal, S., Mohan, A., Madan, K., Tiwari, P., Bhatnagar, S., Trikha, A., Dosi, R., Bhopale, S., Viswanath, R., Hadda, V., Guleria, R., & Baldwa, B. (2021). Effect of proning in patients with COVID-19 acute hypoxemic respiratory failure receiving noninvasive oxygen therapy. Lung India, 38(7), 6. https://doi.org/10.4103/lungindia.lungindia_794_20

Susanto, G., & Sukmarini, L. (2022). The Effectiveness of Prone Positioning in Patients with Acute Respiratory Distress Syndrome: A Literature Review. Jurnal Aisyah: Jurnal Ilmu Kesehatan, 7(2), 647–654. https://doi.org/10.30604/jika.v7i2.985

Taylor, S. P., Bundy, H., Smith, W. M., Skavroneck, S., Taylor, B., & Kowalkowski, M. A. (2021). Awake prone positioning strategy for nonintubated hypoxic patients with COVID-19: a pilot trial with embedded implementation evaluation. Annals of the American Thoracic Society, 18(8), 1360–1368. https://doi.org/10.1513/AnnalsATS.202009-1164OC

Tufanaru, C., Munn, Z., Aromataris, E., Campbell, J., & Hopp, L. (2020). Systematic reviews of effectiveness. In E. Aromataris & Z. Munn (Eds.), JBI Manual for Evidence Synthesis. JBI. https://synthesismanual.jbi.global

Villar, J., Blanco, J., & Kacmarek, R. M. (2016). Current incidence and outcome of the acute respiratory distress syndrome. Current Opinion in Critical Care, 22(1), 1–6. https://doi.org/10.1097/MCC.0000000000000266

Weatherald, J., Parhar, K. K. S., Al Duhailib, Z., Chu, D. K., Granholm, A., Solverson, K., Lewis, K., Møller, M. H., Alshahrani, M., Belley-Cote, E., Loroff, N., Qian, E. T., Gatto, C. L., Rice, T. W., Niven, D., Stelfox, H. T., Fiest, K., Cook, D., Arabi, Y. M., & Alhazzani, W. (2022). Efficacy of awake prone positioning in patients with covid-19 related hypoxemic respiratory failure: systematic review and meta-analysis of randomized trials. BMJ, 379, e071966. https://doi.org/10.1136/bmj-2022-071966

World Health Organization. (2023). Clinical management of Covid-19: Living guideline, 13 January 2023. In World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-2


Article Statistic

Abstract view : 122 times
PDF (Bahasa Indonesia) views : 36 times

Dimensions Metrics

How To Cite This :

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.