Publication:
Awake proning as an adjunctive therapy for refractory hypoxemia in non-intubated patients with COVID-19 acute respiratory failure: Guidance from an international group of healthcare workers

Issued Date

2021-05-05

Resource Type

Article

ISSN

14761645
00029637

DOI

10.4269/ajtmh.20-1445

Other identifier(s)

2-s2.0-85105548761

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

American Journal of Tropical Medicine and Hygiene. Vol.104, No.5 (2021), 1676-1686

Suggested Citation

Willemke Stilma, Eva Åkerman, Antonio Artigas, Andrew Bentley, Lieuwe D. Bos, Thomas J.C. Bosman, Hendrik De Bruin, Tobias Brummaier, Laura A. Buiteman-Kruizinga, Francesco Carcò, Gregg Chesney, Cindy Chu, Paul Dark, Arjen M. Dondorp, Harm J.H. Gijsbers, Mary Ellen Gilder, Domenico L. Grieco, Rebecca Inglis, John G. Laffey, Giovanni Landoni, Weihua Lu, Lisa M.N. Maduro, Rose McGready, Bairbre McNicholas, Diego De Mendoza, Luis Morales-Quinteros, Francois Nosten, Alfred Papali, Gianluca Paternoster, Frederique Paulus, Luigi Pisani, Eloi Prud'Homme, Jean Damien Ricard, Oriol Roca, Chiara Sartini, Vittorio Scaravilli, Marcus J. Schultz, Chaisith Sivakorn, Peter E. Spronk, Jaques Sztajnbok, Youssef Trigui, Kathleen M. Vollman, Margaretha C.E. Van Der Woude Awake proning as an adjunctive therapy for refractory hypoxemia in non-intubated patients with COVID-19 acute respiratory failure: Guidance from an international group of healthcare workers. American Journal of Tropical Medicine and Hygiene. Vol.104, No.5 (2021), 1676-1686. doi:10.4269/ajtmh.20-1445 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77288

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Title

Awake proning as an adjunctive therapy for refractory hypoxemia in non-intubated patients with COVID-19 acute respiratory failure: Guidance from an international group of healthcare workers

Author(s)

Willemke Stilma
 Eva Åkerman
 Antonio Artigas
 Andrew Bentley
 Lieuwe D. Bos
 Thomas J.C. Bosman
 Hendrik De Bruin
 Tobias Brummaier
 Laura A. Buiteman-Kruizinga
 Francesco Carcò
 Gregg Chesney
 Cindy Chu
 Paul Dark
 Arjen M. Dondorp
 Harm J.H. Gijsbers
 Mary Ellen Gilder
 Domenico L. Grieco
 Rebecca Inglis
 John G. Laffey
 Giovanni Landoni
 Weihua Lu
 Lisa M.N. Maduro
 Rose McGready
 Bairbre McNicholas
 Diego De Mendoza
 Luis Morales-Quinteros
 Francois Nosten
 Alfred Papali
 Gianluca Paternoster
 Frederique Paulus
 Luigi Pisani
 Eloi Prud'Homme
 Jean Damien Ricard
 Oriol Roca
 Chiara Sartini
 Vittorio Scaravilli
 Marcus J. Schultz
 Chaisith Sivakorn
 Peter E. Spronk
 Jaques Sztajnbok
 Youssef Trigui
 Kathleen M. Vollman
 Margaretha C.E. Van Der Woude

Other Contributor(s)

Facoltà di Medicina e Chirurgia
 Faculty of Tropical Medicine, Mahidol University
 Faculty of Biology, Medicine and Health
 Université Paris Cité
 Manchester University NHS Foundation Trust
 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
 Ospedale San Carlo, Potenza
 Gelre Ziekenhuizen
 Fondazione Policlinico Universitario Agostino Gemelli IRCCS
 Instituto de Infectologia Emilio Ribas
 University Hospital Galway
 Università Cattolica del Sacro Cuore, Campus di Roma
 University of Oxford
 Wannan Medical College
 NYU Grossman School of Medicine
 IRCCS Ospedale San Raffaele
 Universitat Autònoma de Barcelona
 Karolinska Universitetssjukhuset
 University of Maryland School of Medicine
 Hospital Universitari Vall d'Hebron
 Karolinska Institutet
 Hospital Universitari de Bellvitge
 Nuffield Department of Medicine
 Hospital de Sabadell
 NUI Galway
 Ospedale Maggiore Policlinico Milano
 AP-HM Assistance Publique - Hôpitaux de Marseille
 The University of Manchester
 Hopital Louis-Mourier
 Universiteit van Amsterdam
 Amsterdam UMC - University of Amsterdam
 Chiang Mai University
 Reinier de Graaf Hospital - SSDZ
 Research Section
 Zuyderland Medisch Centrum
 Advancing Nursing LLC
 Centre Hospitalier d'Aix-en-Provence
 Division of Pulmonary and Critical Care Medicine

Abstract

Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. Agrowing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6-12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.

Keyword(s)

Immunology and Microbiology
 Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/77288

Collections

Scopus 2021