TY - JOUR
T1 - Awake prone positioning in acute hypoxaemic respiratory failure
T2 - An international expert guidance
AU - Pavlov, Ivan
AU - Li, Jie
AU - Kharat, Aileen
AU - Luo, Jian
AU - Ibarra-Estrada, Miguel
AU - Perez, Yonatan
AU - McNicolas, Bairbre
AU - Poole, Daniele
AU - Roca, Oriol
AU - Vines, David
AU - Tavernier, Elsa
AU - Allen, Thérèse
AU - Shyamsundar, Murali
AU - Ehrmann, Stephan
AU - Simpson, Steven Q.
AU - Guérin, Claude
AU - Laffey, John G.
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2023/12
Y1 - 2023/12
N2 - Background: Awake prone positioning (APP) of non-intubated patients with acute hypoxaemic respiratory failure (AHRF) has been inconsistently adopted into routine care of patients with COVID-19, likely due to apparent conflicting evidence from recent trials. This short guideline aims to provide evidence-based recommendations for the use of APP in various clinical scenarios. Methods: An international multidisciplinary panel, assembled for their expertise and representativeness, and supported by a methodologist, performed a systematic literature search, summarized the available evidence derived from randomized clinical trials, and developed recommendations using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. Results: The panel strongly recommends that APP rather than standard supine care be used in patients with COVID-19 receiving advanced respiratory support (high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation). Due to lack of evidence from randomized controlled trials, the panel provides no recommendation on the use of APP in patients with COVID-19 supported with conventional oxygen therapy, nor in patients with AHRF due to causes other than COVID-19. Conclusion: APP should be routinely implemented in patients with COVID-19 receiving advanced respiratory support.
AB - Background: Awake prone positioning (APP) of non-intubated patients with acute hypoxaemic respiratory failure (AHRF) has been inconsistently adopted into routine care of patients with COVID-19, likely due to apparent conflicting evidence from recent trials. This short guideline aims to provide evidence-based recommendations for the use of APP in various clinical scenarios. Methods: An international multidisciplinary panel, assembled for their expertise and representativeness, and supported by a methodologist, performed a systematic literature search, summarized the available evidence derived from randomized clinical trials, and developed recommendations using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. Results: The panel strongly recommends that APP rather than standard supine care be used in patients with COVID-19 receiving advanced respiratory support (high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation). Due to lack of evidence from randomized controlled trials, the panel provides no recommendation on the use of APP in patients with COVID-19 supported with conventional oxygen therapy, nor in patients with AHRF due to causes other than COVID-19. Conclusion: APP should be routinely implemented in patients with COVID-19 receiving advanced respiratory support.
KW - Acute hypoxaemic respiratory failure
KW - Awake prone positioning
KW - COVID-19
KW - Guideline
KW - High flow nasal cannula
KW - Non-invasive ventilation
KW - Oxygen therapy
KW - Prone position
UR - https://www.scopus.com/pages/publications/85168737793
U2 - 10.1016/j.jcrc.2023.154401
DO - 10.1016/j.jcrc.2023.154401
M3 - Review article
C2 - 37639921
AN - SCOPUS:85168737793
SN - 0883-9441
VL - 78
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 154401
ER -