![]() ![]() 1 The findings of several observational studies suggested that prone positioning may improve oxygenation among patients on both low-flow (e.g., nasal prong oxygen) and higher-flow oxygen delivery devices (e.g., high-flow nasal cannula) not yet receiving mechanical ventilation. 2ĭuring the COVID-19 pandemic, as health care systems scrambled to accommodate the surge in patients with acute respiratory failure, reports emerged of the potential benefit of prone positioning of patients with COVID-19 who were hypoxic and not intubated. Ventilation in the prone position is a technique that has been employed and evaluated over the past 3 decades among patients who are mechanically ventilated for all severities of ARDS, with the greatest benefits seen among those with moderate to severe ARDS, for which it is now considered standard of care. The mainstays of the management of ARDS are treating the underlying precipitant and supportive care, which includes mechanical ventilation with every effort to mitigate ventilator-associated lung injury. Severe acute respiratory failure may result in acute respiratory distress syndrome (ARDS) - a form of noncardiogenic pulmonary edema precipitated by a direct (e.g., pneumonia) or indirect (e.g., pancreatitis) injury. 1 Severe pneumonia can result in acute hypoxic respiratory failure necessitating supplemental oxygen therapy or respiratory support with mechanical ventilation. Pneumonia is the most common reason for admission to hospital among patients with coronavirus disease 2019 (COVID-19), and many such patients will require supplemental oxygen. ![]() Randomized controlled trials are needed to better understand the benefits and adverse effects of prone positioning in patients with COVID-19 who are breathing spontaneously. Prone positioning for patients who are mechanically ventilated comes with risks related to dislodgement of endotracheal tubes and access lines, which are reduced for awake, nonventilated patients however, risks related to pressure may be mitigated as patients who are awake can change position independently. Studies have not yet provided clinicians with tools to predict which patients with COVID-19 are most likely to improve with prone positioning, nor have they proven whether prone positioning is able to delay or avoid the need for invasive ventilation or shown a mortality benefit. Prone positioning in patients with hypoxic respiratory failure who are awake, spontaneously breathing and not intubated is possible in noncritical care settings evidence has emerged of its use in the management of patients with coronavirus disease 2019 (COVID-19) pneumonia, showing potential for improved oxygenation and decreased dyspnea. Nam risus ante, dapibus a molestie consequat, ultrices ac magna.Prone positioning has been widely adopted into standard practice for patients with severe acute respiratory distress syndrome who are mechanically ventilated based on high-quality evidence. Nam lacinia pulvinar tortor nec facilisis. Donec aliquet. sectetur adipiscsectetur adipiscing elit. Fusce dui lectus, congue vel laoreet ac, dictum vitae odio. Nam risus ante, dapibus a molestie consequat, ultrices ac magna. Nam risus ante, dapibus a mo sectetur adipiscing elsectetur adipiscing elit. ![]() Fusce dui lectus, congue vel laoreet a sectetur adipiscing elisectetur adipiscing elit. Nam lac sectetur adipiscing e sectetur adipiscing elit. ![]()
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