Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers.
Authors
Stilma, WillemkeÅkerman, Eva
Artigas, Antonio
Bentley, Andrew
Bos, Lieuwe D
Bosman, Thomas J C
de Bruin, Hendrik
Brummaier, Tobias
Buiteman-Kruizinga, Laura A
Carcò, Francesco
Chesney, Gregg
Chu, Cindy
Dark, Paul
Dondorp, Arjen M
Gijsbers, Harm J H
Gilder, Mary Ellen
Grieco, Domenico L
Inglis, Rebecca
Laffey, John G
Landoni, Giovanni
Lu, Weihua
Maduro, Lisa M N
McGready, Rose
McNicholas, Bairbre
de Mendoza, Diego
Morales-Quinteros, Luis
Nosten, Francois
Papali, Alfred
Paternoster, Gianluca
Paulus, Frederique
Pisani, Luigi
Prud'homme, Eloi
Ricard, Jean-Damien
Roca, Oriol
Sartini, Chiara
Scaravilli, Vittorio
Schultz, Marcus J
Sivakorn, Chaisith
Spronk, Peter E
Sztajnbok, Jaques
Trigui, Youssef
Vollman, Kathleen M
van der Woude, Margaretha C E
Issue Date
2021-03-11Keywords
COVID-19CORONAVIRUS
RESPIRATORY DISORDER
Metadata
Show full item recordJournal
The American journal of tropical medicine and hygieneDOI
10.4269/ajtmh.20-1445PubMed ID
33705348Abstract
Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6-12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.Item Type
ArticleLanguage
enEISSN
1476-1645ae974a485f413a2113503eed53cd6c53
10.4269/ajtmh.20-1445