Awake prone positioning in acute hypoxaemic respiratory failure: An international expert guidance.

Humans COVID-19 / therapy Prone Position Wakefulness Oxygen Respiratory Insufficiency / therapy
Acute hypoxaemic respiratory failure Awake prone positioning COVID-19 Guideline High flow nasal cannula Non-invasive ventilation Oxygen therapy Prone position

Journal

Journal of critical care
ISSN: 1557-8615
Titre abrégé: J Crit Care
Pays: United States
ID NLM: 8610642

Informations de publication

Date de publication:
12 2023
Historique:
received: 17 04 2023
revised: 12 07 2023
accepted: 11 08 2023
medline: 25 9 2023
pubmed: 29 8 2023
entrez: 28 8 2023
Statut: ppublish

Résumé

Awake prone positioning (APP) of non-intubated patients with acute hypoxaemic respiratory failure (AHRF) has been inconsistently adopted into routine care of patients with COVID-19, likely due to apparent conflicting evidence from recent trials. This short guideline aims to provide evidence-based recommendations for the use of APP in various clinical scenarios. An international multidisciplinary panel, assembled for their expertise and representativeness, and supported by a methodologist, performed a systematic literature search, summarized the available evidence derived from randomized clinical trials, and developed recommendations using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. The panel strongly recommends that APP rather than standard supine care be used in patients with COVID-19 receiving advanced respiratory support (high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation). Due to lack of evidence from randomized controlled trials, the panel provides no recommendation on the use of APP in patients with COVID-19 supported with conventional oxygen therapy, nor in patients with AHRF due to causes other than COVID-19. APP should be routinely implemented in patients with COVID-19 receiving advanced respiratory support.

Sections du résumé

BACKGROUND
Awake prone positioning (APP) of non-intubated patients with acute hypoxaemic respiratory failure (AHRF) has been inconsistently adopted into routine care of patients with COVID-19, likely due to apparent conflicting evidence from recent trials. This short guideline aims to provide evidence-based recommendations for the use of APP in various clinical scenarios.
METHODS
An international multidisciplinary panel, assembled for their expertise and representativeness, and supported by a methodologist, performed a systematic literature search, summarized the available evidence derived from randomized clinical trials, and developed recommendations using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology.
RESULTS
The panel strongly recommends that APP rather than standard supine care be used in patients with COVID-19 receiving advanced respiratory support (high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation). Due to lack of evidence from randomized controlled trials, the panel provides no recommendation on the use of APP in patients with COVID-19 supported with conventional oxygen therapy, nor in patients with AHRF due to causes other than COVID-19.
CONCLUSION
APP should be routinely implemented in patients with COVID-19 receiving advanced respiratory support.

Identifiants

DOI: 10.1016/j.jcrc.2023.154401 PMID: 37639921
pubmed: 37639921
pii: S0883-9441(23)00150-8
doi: 10.1016/j.jcrc.2023.154401
pii:
doi:

Substances chimiques

Oxygen S88TT14065

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

154401

Informations de copyright

Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest IP discloses an unrestricted research grant and speaker fees from Fisher & Paykel Healthcare Ltd. and an unrestricted research grant from OpenAI Inc. JLi discloses research funding from Fisher & Paykel Healthcare, Aerogen, Rice Foundation, and the American Association for Respiratory Care, and speaker fees from the American Association for Respiratory Care, Aerogen, Heyer, and Fisher & Paykel Healthcare. SE discloses consultancy fees from Aerogen, research support from Aerogen and Fisher & Paykel Healthcare, and travel reimbursements from Aerogen and Fisher & Paykel Healthcare. DV discloses research funding from Teleflex Medical and Rice Foundation. OR discloses a research grant from Hamilton Medical and Fisher & Paykel, and speaker fees from Hamilton Medical, Ambu, Fisher & Paykel and Aerogen, and non-financial research support from Timpel. YP discloses research support and travel reimbursement from Fisher & Paykel Healthcare. JGL discloses consulting fees from Baxter Healthcare and Cellenkos. MS discloses speaker fees from Fisher & Paykel Healthcare Ltd. and consultancy fees from Aerogen. All other authors have no conflicts to disclose.

Auteurs

Ivan Pavlov (I)

Department of Emergency Medicine, Hôpital de Verdun, Montréal, Québec, Canada.

Jie Li (J)

Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA.

Aileen Kharat (A)

Department of Respiratory Medicine, Geneva University Hospital, Geneva, Switzerland.

Jian Luo (J)

Respiratory Medicine Unit and Oxford NIHR Biomedical Research Centre, NDM Experimental Medicine, University of Oxford, Oxford, UK.

Miguel Ibarra-Estrada (M)

Unidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.

Yonatan Perez (Y)

Médecine Intensive Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

Bairbre McNicolas (B)

Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals and School of Medicine, University of Galway, Galway, Ireland.

Daniele Poole (D)

Operative Unit of Anesthesia and Intensive Care, S. Martino Hospital, Belluno, Italy.

Oriol Roca (O)

Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Parc del Taulí 1, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.

David Vines (D)

Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA.

Elsa Tavernier (E)

Methods in Patient-Centered Outcomes and Health Research, INSERM UMR 1246, Nantes, France; Clinical Investigation Centre, INSERM 1415 CHRU Tours, Tours, France.

Thérèse Allen (T)

Retired Nurse, and Patient Representative, Galway, Ireland.

Murali Shyamsundar (M)

Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK.

Stephan Ehrmann (S)

Médecine Intensive Réanimation, Clinical Investigation Center, INSERM 1415, INSERM, Centre d'Etude des Pathologies Respiratoires, Université de Tours - All in Tours, U1100, France.

Steven Q Simpson (SQ)

University of Kansas Medical Center, Kansas City, KS, USA.

Claude Guérin (C)

Université de Lyon, Lyon, France; Institut Mondor de Recherches Biomédicales, INSERM 955 CNRS, 7200, Créteil, France.

John G Laffey (JG)

Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals and School of Medicine, University of Galway, Galway, Ireland. Electronic address: john.laffey@universityofgalway.ie.

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Classifications MeSH

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