Awake Prone Positioning for COVID-19 Patients COVID19 coronavirus covid SARSCoV2 lung breathing
Awake prone positioning in patients with acute respiratory distress syndromeHow to perform awake prone positioning in COVID-19 patients Awake prone positioning is a well-established non-pharmacological intervention to improve lung oxygenation. During the ongoing coronavirus disease 2019 pandemic, this process has received much attention for improving clinical outcomes in non-intubated COVID-19 patients with hypoxemic respiratory failure.
The basic working principle is changing the patient's position from supine to prone to increase oxygenation. Keeping the body in prone position helps maintain a more homogeneous lung ventilation from dorsal to ventral regions compared to the supine position. In spontaneously breathing patients with hypoxemic respiratory failure, awake prone positioning has been found to reduce hypoxemia without causing any detrimental side effects; however, the effect is short-term and abolished after returning to the supine position. Moreover, the process has been found to limit the requirement of invasive mechanical ventilation in these patients.
In COVID-19 patients with severe acute respiratory distress syndrome, prone positioning, and oxygen therapy have been found to improve lung oxygenation and mitigate invasive ventilation requirements. Early application of awake prone positioning in COVID-19 patients has improved pulmonary heterogeneity and reduced mortality.
There is evidence contradicting the beneficial effects of prone positioning in COVID-19 patients with respiratory distress. Some clinical trials involving COVID-19 patients with hypoxemic respiratory failure could not find any clinical benefits of prone positioning. Gravitational forces generated during prone positioning help improve lung secretion drainage. The process may also increase coughing. These factors may lead to viral contamination of the surrounding environment.
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