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Review ArticleNarrative Review

Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS

Felipe González-Seguel, Juan José Pinto-Concha, Nadine Aranis and Jaime Leppe
Respiratory Care October 2021, respcare.09194; DOI: https://doi.org/10.4187/respcare.09194
Felipe González-Seguel
Servicio de Medicina Física y Rehabilitación and Departamento de Paciente Crítico, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
Master Program in Physical Therapy and Rehabilitation, School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
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  • For correspondence: [email protected]
Juan José Pinto-Concha
Master Program in Physical Therapy and Rehabilitation, School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
Centro de Paciente Crítico Adulto, Clínica INDISA, Santiago, Chile.
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Nadine Aranis
Servicio de Medicina Física y Rehabilitación and Departamento de Paciente Crítico, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
Master Program in Physical Therapy and Rehabilitation, School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
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Jaime Leppe
Master Program in Physical Therapy and Rehabilitation, School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
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Abstract

BACKGROUND: Prone positioning is a therapy utilized globally to improve gas exchange, minimize ventilator-induced lung injury, and reduce mortality in ARDS, particularly during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Whereas the respiratory benefits of prone positioning in ARDS have been accepted, the concurrent complications could be undervalued. Therefore, this study aimed to identify the adverse events (AEs) related to prone positioning in ARDS and, secondarily, to collect strategies and recommendations to mitigate these AEs.

METHODS: In this scoping review, we searched recommendation documents and original studies published between June 2013 and November 2020 from 6 relevant electronic databases and the websites of intensive care societies.

RESULTS: We selected 41 documents from 121 eligible documents, comprising 13 recommendation documents and 28 original studies (involving 1,578 subjects and 994 prone maneuvers). We identified > 40 individual AEs, and the highest-pooled occurrence rates were those of severe desaturation (37.9%), barotrauma (30.5%), pressure sores (29.7%), ventilation-associated pneumonia (28.2%), facial edema (16.7%), arrhythmia (15.4%), hypotension (10.2%), and peripheral nerve injuries (8.1%). The reported mitigation strategies during prone positioning included alternate face rotation (18 [43.9%]), repositioning every 2 h (17 [41.5%]), and the use of pillows under the chest and pelvis (14 [34.1%]). The reported mitigation strategies for performing the prone maneuver comprised one person being at the headboard (23 [56.1%]), the use of a pre-maneuver safety checklist (18 [43.9%]), vital sign monitoring (15 [36.6%]), and ensuring appropriate ventilator settings (12 [29.3%]).

CONCLUSIONS: We identified > 40 AEs reported in prone positioning ARDS studies, including additional AEs not yet reported by previous systematic reviews. The pooled AE proportions collected in this review could guide research and clinical practice decisions, and the strategies to mitigate AEs could promote future consensus-based recommendations.

  • prone position
  • mechanical ventilation
  • ARDS
  • respiratory failure
  • adverse events
  • complications

Footnotes

  • Correspondence: Felipe González-Seguel PT MSc, Servicio de Medicina Física y Rehabilitación and Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Av. Plaza 680, Santiago, Chile. E-mail: feligonzalezs{at}udd.cl
  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 67 (7)
Respiratory Care
Vol. 67, Issue 7
1 Jul 2022
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Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS
Felipe González-Seguel, Juan José Pinto-Concha, Nadine Aranis, Jaime Leppe
Respiratory Care Oct 2021, respcare.09194; DOI: 10.4187/respcare.09194

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Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS
Felipe González-Seguel, Juan José Pinto-Concha, Nadine Aranis, Jaime Leppe
Respiratory Care Oct 2021, respcare.09194; DOI: 10.4187/respcare.09194
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Keywords

  • prone position
  • mechanical ventilation
  • ARDS
  • respiratory failure
  • adverse events
  • complications

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