Prone ventilation: does it have a role in neonates

In patients of various ages undergoing mechanical ventilation, it has been observed that positions other than the standard supine position, such as the prone position, may improve respiratory parameters and outcome. The benefits of these positions have not been clearly defined for critically ill newborns receiving mechanical ventilation.

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Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position

Journal of the Intensive Care Society ◽

10.1177/1751143719900100 ◽

2020 ◽

pp. 175114371990010 ◽

Cited By ~ 1

Author(s):

Raymond Dominic Savio ◽

Rajalakshmi Parasuraman ◽

Daphnee Lovesly ◽

Bhuvaneshwari Shankar ◽

Lakshmi Ranganathan ◽

...

Keyword(s):

Mechanical Ventilation ◽

Enteral Nutrition ◽

Critically Ill ◽

Prone Position ◽

Supine Position ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Apache Ii ◽

Apache Ii Score ◽

The Mean

Aim To assess the feasibility, tolerance and effectiveness of enteral nutrition in critically ill patients receiving invasive mechanical ventilation in the prone position for severe Acute Respiratory Distress Syndrome (ARDS). Methods Prospective observational study conducted in a multidisciplinary critical care unit of a tertiary care hospital from January 2013 until July 2015. All patients with ARDS who received invasive mechanical ventilation in prone position during the study period were included. Patients’ demographics, severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE II) score), baseline markers of nutritional status (subjective global assessment (SGA) and body mass index), details of nutrition delivery during prone and supine hours and outcomes (Length of stay and discharge status) were recorded. Results Fifty-one patients met inclusion criteria out of whom four patients were excluded from analysis since they did not receive any enteral nutrition due to severe hemodynamic instability. The mean age of patients was 46.4 ± 12.9 years, with male:female ratio of 7:3. On admission, SGA revealed moderate malnutrition in 51% of patients and the mean APACHE II score was 26.8 ± 9.2. The average duration of prone ventilation per patient was 60.2 ± 30.7 h. All patients received continuous nasogastric/orogastric feeds. The mean calories (kcal/kg/day) and protein (g/kg/day) prescribed in the supine position were 24.5 ± 3.8 and 1.1 ± 0.2 while the mean calories and protein prescribed in prone position were 23.5 ± 3.6 and 1.1 ± 0.2, respectively. Percentage of prescribed calories received by patients in supine position was similar to that in prone position (83.2% vs. 79.6%; P = 0.12). Patients received a higher percentage of prescribed protein in supine compared to prone position (80.8% vs. 75%, P = 0.02). The proportion of patients who received at least 75% of the caloric and protein goals was 37 (78.7%) and 37 (78.7%) in supine and 32 (68.1%) and 21 (44.6%) in prone position. Conclusion In critically ill patients receiving invasive mechanical ventilation in the prone position, enteral nutrition with nasogastric/orogastric feeding is feasible and well tolerated. Nutritional delivery of calories and proteins in prone position is comparable to that in supine position.

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A Review of the Tolerance and Adequacy of Enteral Nutrition Administered in the Prone Position in Critically Ill Patients Receiving Mechanical Ventilation

Current Developments in Nutrition ◽

10.1093/cdn/nzab029_017 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 216-216

Author(s):

Carolyn Ellis ◽

Miranda Brown ◽

Kristine Anne Del Rosario ◽

Paige Heiden ◽

Gabriella Salazar ◽

...

Keyword(s):

Mechanical Ventilation ◽

Enteral Nutrition ◽

Critically Ill ◽

Prone Position ◽

Supine Position ◽

Dropout Rate ◽

Cochrane Library ◽

Prone Positioning ◽

Inclusion Criteria ◽

Mechanically Ventilated

Abstract Objectives During the coronavirus 2019 (COVID-19) pandemic, more patients require enteral nutrition (EN) while mechanically ventilated in the prone position (PP). Prone positioning may improve oxygenation in patients receiving mechanical ventilation; however, it is unclear how it affects EN adequacy and tolerance. This review explored how EN delivered in the PP impacts EN tolerance (vomiting, diarrhea, abdominal distention, or aspiration pneumonia) and adequacy (meeting estimated energy and protein requirements) in critically ill adults receiving mechanical ventilation. Methods A literature search was conducted in PubMed, CINAHL, Academic Search Premier, and Cochrane Library for English-language studies exploring EN administered in the PP published between 2000–2020. Studies that met inclusion criteria enrolled adult patients in intensive care units with acute respiratory distress syndrome or other respiratory conditions requiring mechanical ventilation, were cohort studies with ≥5 patients per study group, and had a dropout rate <20%. Studies were excluded if patients received only parenteral nutrition. Results Of 45 studies, 4 met inclusion criteria. Three were prospective cohorts and 1 was a before-after study. When comparing EN tolerance in the PP and supine positions, 1 study found no difference in diarrhea occurrence, 2 studies found no difference in the rate of vomiting, and 1 study found significantly higher rates of vomiting while in the PP. For feeding adequacy, 2 studies found no difference in the % of calories received when administered in prone or supine positions, while 1 study found patients in the PP received significantly less EN volume than patients in the supine position. One study concluded that prophylactic prokinetic agent use and head elevation while prone resulted in larger EN volumes delivered with reduced vomiting risk. Conclusions These results suggest the adequacy of EN delivered in the PP is comparable to the supine position and PP does not substantially increase vomiting or diarrhea risk. Prone positioning should not be considered an immediate contraindication to EN for adults receiving mechanical ventilation. These findings may apply to the nutritional management of critically ill mechanically ventilated adults with COVID-19. Funding Sources None

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Effects of prone and supine position on oxygenation and inflammatory mediator in a hydrochloric acid-induced lung dysfunction in rats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502008000500011 ◽

2008 ◽

Vol 23 (5) ◽

pp. 451-455 ◽

Cited By ~ 2

Author(s):

Wagner Rogério Souza de Oliveira ◽

Ivaldo da Silva ◽

Ricardo Santos Simões ◽

Luiz Fernando Portugal Fuchs ◽

Ricardo Martins Oliveira-Filho ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hydrochloric Acid ◽

Prone Position ◽

Supine Position ◽

Inflammatory Mediator ◽

Partial Pressure Of Oxygen ◽

Total Proteins ◽

Partial Pressures ◽

Tnf Α ◽

Lung Dysfunction

PURPOSE: To compare the effectiveness of mechanical ventilation of supine versus prone position in hydrochloric acid (HCl)-induced lung dysfunction. METHODS: Twenty, adult, male, Wistar-EPM-1 rats were anesthetized and randomly grouped (n=5 animals per group) as follows: CS-MV (mechanical ventilation in supine position); CP-MV (mechanical ventilation in prone position); bilateral instillation of HCl and mechanical ventilation in supine position (HCl+S); and bilateral instillation of HCl and mechanical ventilation in prone position (HCl+P). All groups were ventilated for 180 minutes. The blood partial pressures of oxygen and carbon dioxide were measured in the time points 0 (zero; 10 minutes before lung injury for stabilization), and at the end of times acid injury, 60, 120 and 180 minutes of mechanical ventilation. At the end of experiment the animals were euthanized, and bronchoalveolar lavages (BALs) were taken to determine the contents of total proteins, inflammatory mediators, and lungs wet-to-dry ratios. RESULTS: In the HCl+P group the partial pressure of oxygen increased when compared with HCl+S (128.0±2.9 mmHg and 111.0±6.7 mmHg, respectively) within 60 minutes. TNF-α levels in BAL do not differ significantly in the HCl+P group (516.0±5.9 pg/mL), and the HCl+S (513.0±10.6 pg/mL). CONCLUSION: The use of prone position improved oxygenation, but did not reduce TNF-α in BAL upon lung dysfunction induced by HCl.

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Prone Versus Supine Position in Intubated COVID-19 Patients With ARDS: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-820756/v1 ◽

2021 ◽

Author(s):

Dita Aditianingsih ◽

Adhrie Sugiarto ◽

Sidharta Kusuma Manggala ◽

Hansen Angkasa ◽

Ahmad Pasha Natanegara

Keyword(s):

Mechanical Ventilation ◽

Mortality Rate ◽

Partial Pressure ◽

Prone Position ◽

Supine Position ◽

Meta Analysis ◽

Arterial Oxygen ◽

Icu Discharge ◽

Significant Difference ◽

Position Group

Abstract BackgroundThis review determined the effect of prone positioning in changes of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, partial pressure of carbon dioxide (PaCO2), mortality rate, ICU length of stay and duration of mechanical ventilation in intubated COVID-19 patients with severe ARDS.MethodsA computer-aided comprehensive electronic bibliographic search from MEDLINE, EMBASE, and Science Direct were conducted. The search comprised the articles written in English and intubated adults (≥ 18 years old) patients with COVID-19. The primary outcome was comparing PaO2/FiO2 ratio between prone and supine position group. Secondary outcomes were PaCO2, ICU discharge, and mortality rate. Review Manager version 5.4 (The Cochrane Collaboration) was used for statistical analyses of the included studies.ResultsA total of 7 articles were determined to be eligible, consisting of 1403 intubated COVID-19 patients with ARDS that showed prone position was associated with a higher PaO2/FiO2 ratio compared to supine position (MD 60.17, 95% CI 46.86 - 73.47; p < 0.00001). Four studies reported the PaCO2 measurement and showed no significant difference between prone and supine position (MD 2.07, 95% CI -2.79 - 6.92; p <0.40). Only two studies reported mortalities, one study had 262 deaths out of 648 patients (40.4%) and one study lost 11 out of 20 patients (55%). One study reported median ICU stay and mechanical ventilation duration (16 days) were significantly longer in prone position group.ConclusionThis meta-analysis showed that prone position improved PaO2/FiO2 ratio in intubated COVID-19 patients with ARDS.

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Nutritional Management of Critically Ill Patients Infected with SARS-CoV-2

International Journal of Nutrology ◽

10.1055/s-0041-1726058 ◽

2021 ◽

Vol 14 (01) ◽

pp. 002-005

Author(s):

Sérgio dos Anjos Garnes ◽

Fernanda Lasakosvitsch ◽

Adriana Bottoni ◽

Andrea Bottoni

Keyword(s):

Mechanical Ventilation ◽

Severe Acute Respiratory Syndrome ◽

Clinical Outcome ◽

Critically Ill ◽

Prone Position ◽

Critically Ill Patients ◽

Protein Intake ◽

Nutritional Therapy ◽

Nutritional Management

AbstractEarly nutritional therapy is essential to ensure the maintenance of adequate energy/protein intake for critically ill patients infected with severe acute respiratory syndrome caused by COVID-19 (SARS-CoV-2) infection. However, this poses a major challenge when it comes to individuals on mechanical ventilation in prone position. Therefore, the present work presents a nutritional therapy flowchart developed for patients with SARS-CoV-2 infection to guide nutritional management and ensure that energy/protein intake goals are met, thus favoring a positive clinical outcome.

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Extracorporeal Membrane Oxygenation and Prone Position Ventilation on Critically ill COVID-19: A Case Report and Literature Review

10.21203/rs.3.rs-32686/v1 ◽

2020 ◽

Author(s):

Jingchen Zhang ◽

Xujian He ◽

Jia Hu ◽

Chenkan Chen ◽

Xuesheng Ye ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Critically Ill ◽

Prone Position ◽

Antiviral Drug ◽

Lung Compliance ◽

Positive Role ◽

Membrane Oxygenation ◽

Comprehensive Rehabilitation

Abstract Background: COVID-19 broke out all over the world, and the mortality rate is extremely high. We report the successful experience of a critically ill COVID-19 patient who underwent long-term extracorporeal membrane oxygenation (ECMO) and multiple prone position ventilation (PPV) treatments.Case presentation: A 53-year-old male patient was sent to our hospital after 11 days of cough and 9 days of fever. According to his CT scan and real-time reverse transcription–polymerase chain reaction assay to throat swap, his nucleic acid was positive, confirming that he was infected with COVID-19. Subsequently, he was sent to ICU for respiratory failure. Afterwards, the patient received antiviral drug, tiny amount of glucocorticoid, and respiratory support, including mechanical ventilation, but the affect was poor. In the 28th day of his admission, veno-venous ECMO and PPV were used, combining with awake ECMO and other comprehensive rehabilitation. In the 17th day of ECMO, the patient started getting better and his chest CT and lung compliance improved. The ECMO was removed in the 27th days, after which the mechanical ventilation was gotten rid of in the 9th day. Then he was transferred to rehabilitation department.Conclusions: COVID-19 can damage lung tissues and cause evident inflammatory exudation, affecting oxygenation function. It is effective to use PPV, awake ECMO, and comprehensive rehabilitation to cure patients with critical COVID-19 and respiratory failure. Our experience hopes to be promoted to play a positive role.

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Extracorporeal Cytokine Hemadsorption in Severe COVID-19 Respiratory Failure

10.1101/2020.06.28.20133561 ◽

2020 ◽

Cited By ~ 1

Author(s):

Marianna Damiani ◽

Lucia Gandini ◽

Francesco Landi ◽

Fabrizio Fabretti ◽

Giuseppe Gritti ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Pilot Study ◽

Critically Ill ◽

Inflammatory Cytokines ◽

Preliminary Data ◽

Invasive Mechanical Ventilation ◽

Laboratory Parameters ◽

Time Points ◽

Respiratory Parameters

AbstractDespite the extracorporeal cytokine hemadsorption device CytoSorb was granted FDA emergency approval for critically ill COVID19 patients, to our knowledge no published studies are currently available to support its use. This manuscript reports the experience of the use of CytoSorb during COVID19 pandemic in Bergamo, Italy. In our pilot study, eleven COVID19 patients requiring invasive mechanical ventilation for a rapidly progressive ARDS were treated with 24 to 48 hours of extracorporeal cytokine hemadsorption.Respiratory and laboratory parameters, including a full set of inflammatory cytokines, were evaluated at different time points. A significant but transient reduction of the hyperinflammatory status was observed, along with the amelioration of the clinical and respiratory parameters.We believe that this manuscript will provide them with important preliminary data on the use of cytokine hemadsorption devices.

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Fluid balance in pediatric patients in prone position: a pragmatic study

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.65.6.839 ◽

2019 ◽

Vol 65 (6) ◽

pp. 839-844

Author(s):

Rosirene Maria Frohlich Dall’ Agnese ◽

Petrônio Fagundes de Oliveira Filho ◽

Caroline A. D. Costa ◽

Cristian T. Tonial ◽

Francisco Bruno ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Adverse Events ◽

Critically Ill ◽

Prone Position ◽

Fluid Balance ◽

Pediatric Patients ◽

Pediatric Intensive Care ◽

Cumulative Fluid Balance

SUMMARY OBJECTIVE: To verify the association between prone position, increased diuresis, and decreased cumulative fluid balance in critically ill pediatric patients who underwent mechanical ventilation (MV) for pulmonary causes and describe adverse events related to the use of the position. METHODS: This is a retrospective observational study. Patients aged between 1 month and 12 years who underwent MV for pulmonary causes, between January 2013 and December 2015, were selected and divided between those who were put on prone position (PG) and those who were not (CG) during the hospitalization at the Pediatric Intensive Care Unit (PICU). Data were analyzed longitudinally from D1 to D4. RESULTS: A total of 77 patients (PG = 37 and CG = 40) were analyzed. The general characteristics of both groups were similar. In the comparison between the groups, there was no increase in diuresis or decrease in cumulative fluid balance in the prone group. In the longitudinal analysis of D1 to D4, we saw that the PG presented higher diuresis (p = 0.034) and a lower cumulative fluid balance (p = 0.001) in D2. Regarding the use of diuretics, there was greater use of furosemide (P <0.001) and spironolactone (P = 0.04) in the PG. There was no increase in adverse events during the use of the prone position. CONCLUSION: The prone position was not associated with increased diuresis or decreased cumulative fluid balance in critically ill pediatric patients who underwent to MV for pulmonary causes.

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