TY - JOUR
T1 - 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
AU - Stilma, Willemke
AU - Åkerman, Eva
AU - Artigas, Antonio
AU - Bentley, Andrew
AU - Bos, Lieuwe D.
AU - Bosman, Thomas J. C.
AU - De Bruin, Hendrik
AU - Brummaier, Tobias
AU - Buiteman-kruizinga, Laura A.
AU - Carcò, Francesco
AU - Chesney, Gregg
AU - Chu, Cindy
AU - Dark, Paul
AU - Dondorp, Arjen M.
AU - Gijsbers, Harm J. H.
AU - Gilder, Mary Ellen
AU - Grieco, Domenico L.
AU - Inglis, Rebecca
AU - Laffey, John G.
AU - Landoni, Giovanni
AU - Lu, Weihua
AU - Maduro, Lisa M. N.
AU - Mcgready, Rose
AU - Mcnicholas, Bairbre
AU - De Mendoza, Diego
AU - Morales-quinteros, Luis
AU - Nosten, Francois
AU - Papali, Alfred
AU - Paternoster, Gianluca
AU - Paulus, Frederique
AU - Pisani, Luigi
AU - Prud’homme, Eloi
AU - Ricard, Jean-damien
AU - Roca, Oriol
AU - Sartini, Chiara
AU - Scaravilli, Vittorio
AU - Schultz, Marcus J.
AU - Sivakorn, Chaisith
AU - Spronk, Peter E.
AU - Sztajnbok, Jaques
AU - Trigui, Youssef
AU - Vollman, Kathleen M.
AU - Van Der Woude, Margaretha C. E.
PY - 2021/3/11
Y1 - 2021/3/11
N2 - 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.
AB - 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.
U2 - 10.4269/ajtmh.20-1445
DO - 10.4269/ajtmh.20-1445
M3 - Article
SN - 0002-9637
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
ER -