Rone positioning may prevent the need for ventilation in COVID-19 patients, says Lancet study

According to a study published in the Lancet Respiratory Medicine journal, prone positioning – patients with severe breathing problems facing them to rotate – can significantly reduce the need for mechanical ventilation in COVID-19 patients soon after admission. The research was conducted in six countries and involved more than 1,100 hospitalized COVID-19 patients who required high-flow nasal cannula oxygen therapy to deliver adequately warm and humidified oxygen.

The findings are from a trial conducted at medical centers in the US, Mexico, France, Canada, Ireland and Spain on critically ill patients with COVD-19 between April 2020 and January 2021. “Breathing in prone position helps the lungs to do more work. efficiently,” explained study lead author Ji Lee, associate professor at Rush University Medical Center in the US.

“When people with severe oxygenation problems lie on their stomachs, this results in better matching of blood flow and ventilation to the lungs, which improves blood oxygen levels,” Lee said. Improvements in oxygen uptake have been reported for patients in the awake position. COVID-19 in retrospective and observational studies, but whether it improves patient-centered outcomes is unknown.

In the latest study, adult patients with COVID-19 who required respiratory support from a high-flow nasal cannula, and agreed to participate in this clinical trial, were randomly assigned to asymptomatic – Horizontally with the face facing upward – or the prone position group. They were asked to stay in that position for as long as they could bear.

Both the supine and prone position groups received high flow oxygen therapy and standard medical management. Patients were continuously monitored to determine whether mechanical ventilation was required.

The study showed that patients in the prone positioning group were significantly less likely to need mechanical ventilation (33% in the awake prone positioning group versus 40 percent in the supine group). Study lead author, Stéphane Ehrmann from the Center Hospitalier Regional Universitaire de Tours (CHRU), France, said that the awake prone position is a safe intervention that can reduce the risk of treatment failure in acute severe hypoxemic respiratory failure due to COVID-19. does.

“Our findings support the routine implementation of the awake prone position in critically ill patients with COVID19 requiring high flow nasal cannula oxygen therapy,” Ehrmann said. “It appears important that physicians improve patient comfort during the prone position, so the patient can remain in position for at least 8 hours a day,” he said.

The researchers noted that reducing the need for mechanical ventilation means that resources can be used most effectively. “Ventilators can really save the lives of people who are no longer able to breathe on their own,” Lee said. “We now have a strategy to keep patients off ventilators, save those devices for the sickest patients who really need them,” Lee said. .

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