Awake Prone-Positioning in Patients on Non-Invasive Ventilation for Management of SARS-CoV-2 Pneumonia: A Systematic Review.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2022-08-18 DOI:10.3390/arm90040046

Geetanjali Tolia Chilkoti, Medha Mohta, Zainab Ahmad, Ashok Kumar Saxena

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Abstract

Introduction: Patients with corona virus disease-19 (COVID-19)-induced acute hypoxemic respiratory failure (AHRF) are often on non-invasive ventilation (NIV) and use of awake prone positioning (PP) may pose concern in terms of feasibility, efficacy and side effects. This systematic review was undertaken to evaluate the feasibility and efficacy of awake PP along with NIV in them.

Materials and methods: A systematic literature search was conducted from the inception of COVID-19 until 15 August 2021. Various factors including feasibility, interface used, outcome, efficacy, side effects and limitations in both intensive care unit (ICU) and Non-ICU setups were noted.

Results: A total of 12 original articles and six case series including 359 patients were involved. Out of it, 40% (n = 122) of patients were in ICU and 60% (n = 237) in Non-ICU areas. Four clinical studies and four case series including 114 patients had evaluated PP along with helmet continuous positive airway pressure (CPAP). All had found PP with helmet CPAP to be feasible and efficacious; however, only one study documented the sustained improvement in oxygenation i.e., 12 h after PP.

Conclusions: The present systematic review observed moderate to serious risk of bias amongst the included studies along with heterogeneity in terms of varied respiratory support amongst patients. However, the use of awake PP in patients on NIV has been found to be feasible and efficacious with no adverse events.

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对接受无创通气治疗的 SARS-CoV-2 肺炎患者采取清醒俯卧位：系统回顾。

导言：电晕病毒病-19（COVID-19）诱发的急性低氧血症呼吸衰竭（AHRF）患者通常使用无创通气（NIV），而使用清醒俯卧位（PP）可能会在可行性、疗效和副作用方面引起关注。本系统性综述旨在评估清醒俯卧位与 NIV 同时使用的可行性和有效性：从 COVID-19 开始至 2021 年 8 月 15 日进行了系统性文献检索。注意到重症监护室（ICU）和非重症监护室设置中的各种因素，包括可行性、使用的界面、结果、疗效、副作用和局限性：结果：共涉及 12 篇原创文章和 6 个病例系列，包括 359 名患者。其中，40%（122 人）的患者住在重症监护室，60%（237 人）的患者住在非重症监护室。四项临床研究和四项病例系列（包括 114 名患者）对使用头盔式持续气道正压（CPAP）的患者进行了评估。所有研究都发现，使用头盔式持续气道正压（CPAP）的密闭式呼吸机是可行且有效的；但是，只有一项研究记录了密闭式呼吸机使用 12 小时后氧合状况的持续改善：本系统综述观察到，纳入的研究存在中度至严重的偏倚风险，患者的呼吸支持也存在异质性。然而，在使用 NIV 的患者中使用清醒 PP 是可行且有效的，而且没有不良反应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.