Considerations of invasive mechanical ventilation in prone position. A narrative review

  • Lorena Díaz-Bohada a. Anesthesiology Department, San Ignacio University Hospital, Pontificia Universidad Javeriana. Bogotá, Colombia. b. School of Medicine, Pontificia Universidad Javeriana. Bogotá, Colombia. https://orcid.org/0000-0003-3863-8993
  • Juan Camilo Segura-Salguero a. Anesthesiology Department, San Ignacio University Hospital, Pontificia Universidad Javeriana. Bogotá, Colombia. b. School of Medicine, Pontificia Universidad Javeriana. Bogotá, Colombia. https://orcid.org/0000-0002-8620-6661
  • Nicolás Felipe Garzón-Beltrán Anesthesiology Department, San Ignacio University Hospital, Pontificia Universidad Javeriana. Bogotá, Colombia. https://orcid.org/0000-0001-8986-9172
  • Daniela Salazar-Balcázar Anesthesiology Department, San Ignacio University Hospital, Pontificia Universidad Javeriana. Bogotá, Colombia. https://orcid.org/0000-0002-0079-6307
  • Margarita Otálora-Estéban a. Anesthesiology Department, San Ignacio University Hospital, Pontificia Universidad Javeriana. Bogotá, Colombia. b. School of Medicine, Pontificia Universidad Javeriana. Bogotá, Colombia. https://orcid.org/0000-0003-3174-1592
Keywords: Mechanical ventilation, Prone position, Prone positioning, COVID -19, Intensive care unit, Critical care, Anesthesiology

Abstract

The evidence regarding logistic considerations and safety events associated with prone position ventilation (PPV) is summarized and a flow diagrama for safe provision of mechanical ventilation in the setting of the COVID-19 pandemic is proposed. A review of the literature was conducted in the Medline via Pubmed, Embase, and Lilacs databases, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Randomized Controlled Trials, Cochrane Database of Abstracts of Reviews of Effects, ProQuest Nursing and Allied Health Database, and Google scholar. Overall, 31 articles were selected for the analysis. The incidence of PPV-related safety events varies between 1% and 11.9% and the most frequent complications are pressure ulcers and airway complications. Early initiation of enteral nutrition is recommended, and transfers are possible in patients on PPV. There is controversy regarding contraindications and recommendations for PPV. Recommendations for its safe provision are based on expert opinions and the establishment of protocols for healthcare staff training. Clinical studies are required to determine which are the recommendations that should be considered for safe and reproducible PPV use during this pandemic.

References

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33. doi: http://www.doi.org/10.1056/NEJMoa2001017.

WHO director-general’s opening remarks at the media briefing on COVID-19 [internet]. 11 de marzo de 2020 [citado: 2020 abr. 9]. Disponible en: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020

Meng L, Qiu H, Wan L, Ai Y, Xue Z, Guo Q, et al. Intubation and ventilation amid the COVID-19 outbreak. Anesthesiology. 2020;132(6):1317-32. doi: http://www.doi.org/10.1097/ALN.0000000000003296.

Calabrese G. Actualización de los riesgos biológicos para anestesiólogos en la atención de pacientes afectados por SARS-CoV-2, COVID-19. Colombian Journal of Anesthesiology. 2020;48(3):138-44. doi: https://doi.org/10.1097/cj9.0000000000000173.

Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788-800. doi: http://www.doi.org/10.1001/jama.2016.0291.

Bloomfield R, Noble DW, Sudlow A. Prone position for acute respiratory failure in adults. Cochrane Database Syst Rev. 2015;(11):1-92. doi: http://www.doi.org/10.1002/14651858.

Guérin C, Reignier J, Richard J-C, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159-68. doi: http://www.doi.org/10.1056/NEJMoa1214103.

Guérin C, Beuret P, Constantin JM, Bellani G, García-Olivares P, Roca O, et al. A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study. Intensive Care Med. 2018;44(1):22-37. doi: http://www.doi.org/10.1056/NEJMoa1214103.

Alonso-Ovies Á, Nin N, Martín MC, Gordo F, Merino P, Añón JM, et al. Safety incidents in airway and mechanical ventilation in Spanish ICUs: The IVeMVA study. J Crit Care. 2018;47:238-44. doi: http://www.doi.org/10.1016/j.jcrc.2018.07.012.

Lee JM, Bae W, Lee YJ, Cho Y-J. The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: updated study level meta-analysis of 11 randomized controlled trials. Crit Care Med. 2014;42(5):1252-62. doi: http://www.doi.org/10.1097/CCM.0000000000000122.

Liu H, Tang Q. Effects of comprehensive nursing intervention on patients with acute respiratory distress syndrome undergoing prone position ventilation. Int J Clin Exp Med. 2020;13(7):5485-91.

Perrillat A, Foletti JM, Lacagne AS, Guyot L, Graillon N. Facial pressure ulcers in COVID-19 patients undergoing prone positioning: How to prevent an underestimated epidemic? J Stomatol Oral Maxillofac Surg. 2020;121(4):442-4. doi: http://www.doi.org/10.1016/j.jormas.2020.06.008.

Alexiou VG, Ierodiakonou V, Dimopoulos G, Falagas ME. Impact of patient position on the incidence of ventilator-associated pneumonia: A meta-analysis of randomized controlled trials. J Crit Care. 2009;24(4):515-22. doi: http://www.doi.org/10.1016/j.jcrc.2008.09.003.

Mancebo J, Fernández R, Blanch L, Rialp G, Gordo F, Ferrer M, et al. A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006;173(11):1233-9. doi: http://www.doi.org/10.1164/rccm.200503-353OC.

Prebio M, Katz-Papatheophilou E, Heindl W, Gelbmann H, Burghuber OC. Verminderung von hautdefekten bei bauchlagerung bei beatmeten intensivpatienten durch das prone-head-support-system: Eine pilotstudie. Wien Klin Wochenschr. 2005;117(3):98-105.

Martínez Campayo N, Bugallo Sanz JI, Mosquera Fajardo I. Symmetric chest pressure ulcers, consequence of prone position ventilation in a patient with COVID‐19. J Eur Acad Dermatology Venereol. 2020;34(11):e672-3. doi: http://www.doi.org/10.1111/jdv.16755.

Kopterides P, Siempos II, Armaganidis A. Prone positioning in hypoxemic respiratory failure: Meta-analysis of randomized controlled trials. J Crit Care. 2009;24(1):89-100. doi: http://www.doi.org/10.1016/j.jcrc.2007.12.014.

Romero CM, Cornejo RA, Gálvez LR, Llanos OP, Tobar EA, Berasaín MA, et al. Extended prone position ventilation in severe acute respiratory distress syndrome: A pilot feasibility study. J Crit Care. 2009;24(1):81-8. doi: http://www.doi.org/10.1016/j.jcrc.2008.02.005.

Bajwa A, Arasi L, Canabal J, Kramer D, Bajwa A, Arasi L, et al. Automated prone positioning and axial rotation in critically ill, nontrauma patients with acute respiratory distress syndrome (ARDS). J Intensive Care Med. 2010;25(2):121-5. doi: http://www.doi.org/10.1177/0885066609356050.

Girard R, Baboi L, Ayzac L, Richard JC, Guérin C. The impact of patient positioning on pressure ulcers in patients with severe ARDS: Results from a multicentre randomised controlled trial on prone positioning. Intensive Care Med. 2014;40(3):397-403. doi: http://www.doi.org/10.1007/s00134-013-3188-1.

Savelkoul C, Rönnau A, van der Steen M, Tjan D. A patient with facial tube fixation scars. Intensive Care Med. 2017;43(10):1512-3. doi: http://www.doi.org/10.1007/s00134-017-4871-4.

Burdet L, Liaudet L, Schaller MD, Broccard AF. Bilateral breast necrosis after prone position ventilation. Intensive Care Med. 2001;27(8):1435. doi: http://www.doi.org/10.1007/s001340100990.

Mora-Arteaga JA, Bernal-Ramírez OJ, Rodríguez SJ. Efecto de la ventilación mecánica en posición prona en pacientes con síndrome de dificultad respiratoria aguda. Una revisión sistemática y metanálisis. Med Intensiva. 2015;39(6):352-65. doi: http://www.doi.org/10.1016/j.medin.2014.11.003.

Taccone P, Pesenti A, Latini R, Polli F, Vagginelli F, Mietto C, et al. Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2009;302(18):1977-84. doi: http://www.doi.org/10.1001/jama.2009.1614.

Munshi L, Del Sorbo L, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO, et al. Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Ann Am Thorac Soc. 2017;14(Suppl 4):S280-8. doi: http://www.doi.org/10.1513/AnnalsATS.201704-343OT.

Guérin C. Prone ventilation in acute respiratory distress syndrome. Eur Respir Rev. 2014;23(132):249-57. doi: http://www.doi.org/10.1183/09059180.00001114.

Ayzac L, Girard R, Baboi L, Beuret P, Rabilloud M, Richard JC, et al. Ventilator-associated pneumonia in ARDS patients: the impact of prone positioning. A secondary analysis of the PROSEVA trial. Intensive Care Med. 2016;42(5):871-8. doi: http://www.doi.org/10.1007/s00134-015-4167-5.

Saran S, Gurjar M, Kanaujia V, Ghosh PS, Gupta A, Mishra P, et al. Effect of prone positioning on intraocular pressure in patients with acute respiratory distress syndrome. Crit Care Med. 2019;47(9):e761-6. doi: http://www.doi.org/10.1097/CCM.0000000000003893.

Trejo-Gabriel-Galán JM, Perea-Rodríguez ME, Aicua-Rapun I, Martínez-Barrio E. Lower cranial nerves paralysis following prone-position mechanical ventilation. Crit Care Med. 2017;45(8):e865-6. doi: http://www.doi.org/10.1097/CCM.0000000000002411.

Flabouris A, Schoettker P, Garner A. ARDS with severe hypoxia - Aeromedical transportation during prone ventilation. Anaesth Intensive Care. 2003;31(6):675-8. doi: http://www.doi.org/10.1177/0310057X0303100613.

DellaVolpe JD, Lovett J, Martin‐Gill C, Guyette FX. Transport of mechanically ventilated patients in the prone position. Prehospital Emerg Care. 2016;20(5):643-7. doi: http://www.doi.org/10.3109/10903127.2016.1162888.

Bruni A, Garofalo E, Grande L, Auletta G, Cubello D, Greco M, et al. Nursing issues in enteral nutrition during prone position in critically ill patients: A systematic review of the literature. Intensive Crit Care Nurs. 2020;60(102899):1-7. doi: http://www.doi.org/10.1016/j.iccn.2020.102899.

Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79. doi: http://www.doi.org/10.1016/j.clnu.2018.08.037.

Reintam Blaser A, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017;43(3):380-98. doi: http://www.doi.org/10.1007/s00134-016-4665-0.

Savio RD, Parasuraman R, Lovesly D, Shankar B, Ranganathan L, Ramakrishnan N, et al. Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position. J Intensive Care Soc. 2021;22(1):41-6. doi: http://www.doi.org/10.1177/1751143719900100.

Messerole E, Peine P, Wittkopp S, Marini JJ, Albert RK. The pragmatics of prone positioning. Am J Respir Crit Care Med. 2002;165(10):1359-63. doi: http://www.doi.org/10.1164/rccm.2107005.

Gordon A, Rabold E, Thirumala R, Husain AA, Patel S, Cheema T. Prone positioning in ARDS. Crit Care Nurs Q. 2019;42(4):371-5. doi: http://www.doi.org/10.1097/CNQ.0000000000000277.

Douglas IS, Rosenthal CA, Swanson DD, Hiller T, Oakes J, Bach J, et al. Safety and outcomes of prolonged usual care prone position mechanical ventilation to treat acute coronavirus disease 2019 hypoxemic respiratory failure. Crit Care Med. 2021;49(3):490-502. doi: http://www.doi.org/10.1097/CCM.0000000000004818.

Canelli R, Spence N, Kumar N, Rodríguez G, González M. The ventilator management team: Repurposing anesthesia workstations and personnel to combat COVID-19. J Intensive Care Med. 2020;35(9):927-32. doi: http://www.doi.org/10.1177/0885066620942097.

Dondorp AM, Hayat M, Aryal D, Beane A, Schultz MJ. Respiratory support in COVID-19 patients, with a focus on resource-limited settings. Am J Trop Med Hyg. 2020;102(6):1191-7. doi: http://www.doi.org/10.4269/ajtmh.20-0283.

Oliveira VM, Piekala DM, Deponti GN, Batista DCR, Minossi SD, Chisté M, et al. Safe prone checklist: Construction and implementation of a tool for performing the prone maneuver. Rev Bras Ter Intensiva. 2017;29(2):131-41. doi: http://www.doi.org/10.5935/0103-507X.20170023.

Vázquez-Valencia A, Santiago-Sáez A, Perea-Pérez B, Labajo-González E, Albarrán-Juan ME. Utilidad de análisis modal de fallos y efectos para mejorar la seguridad en la movilización del paciente crítico intubado TT [Usefulness of failure mode and effects analysis for improving mobilization safety in critically ill patients]. Colombian Journal of Anesthesiology. 2018;46(1):3-10. doi: https://doi.org/10.1097/cj9.0000000000000002.

Mouli TC, Davuluri A, Vijaya S, Priyanka AY, Mishra S. Effectiveness of simulation based teaching of ventilatory management among non-anaesthesiology residents to manage COVID 19 pandemic - A Quasi experimental cross sectional pilot study. Indian J Anaesth. 2020;64(14):136. doi: http://www.doi.org/10.4103/ija.IJA_452_20.

How to Cite
1.
Díaz-Bohada L, Segura-Salguero JC, Garzón-Beltrán NF, Salazar-Balcázar D, Otálora-Estéban M. Considerations of invasive mechanical ventilation in prone position. A narrative review. Colomb. J. Anesthesiol. [Internet]. 2021Nov.9 [cited 2022Jun.27];50(3). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1013

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Published
2021-11-09
How to Cite
1.
Díaz-Bohada L, Segura-Salguero JC, Garzón-Beltrán NF, Salazar-Balcázar D, Otálora-Estéban M. Considerations of invasive mechanical ventilation in prone position. A narrative review. Colomb. J. Anesthesiol. [Internet]. 2021Nov.9 [cited 2022Jun.27];50(3). Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1013
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Narrative review
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