PMID- 32963439
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220417
IS  - 0972-5229 (Print)
IS  - 1998-359X (Electronic)
IS  - 0972-5229 (Linking)
VI  - 24
IP  - 7
DP  - 2020 Jul
TI  - Voluntary Prone Position for Acute Hypoxemic Respiratory Failure in Unintubated 
      Patients.
PG  - 557-562
LID - 10.5005/jp-journals-10071-23495 [doi]
AB  - Severe hypoxemic respiratory failure is frequently managed with invasive 
      mechanical ventilation with or without prone position (PP). We describe 13 cases 
      of nonhypercapnic acute hypoxemic respiratory failure (AHRF) of varied etiology, 
      who were treated successfully in PP without the need for intubation. Noninvasive 
      ventilation (NIV), high-flow oxygen via nasal cannula, supplementary oxygen with 
      venturi face mask, or nasal cannula were used variedly in these patients. 
      Mechanical ventilatory support is offered to patients with AHRF when other 
      methods, such as NIV and oxygen via high-flow nasal cannula, fail. Invasive 
      mechanical ventilation is fraught with complications which could be immediate, 
      ranging from worsening of hypoxemia, worsening hemodynamics, loss of airway, and 
      even death. Late complications could be ventilator-associated pneumonia, 
      biotrauma, tracheal stenosis, etc. Prone position is known to improve oxygenation 
      and outcome in adult respiratory distress syndrome. We postulated that 
      positioning an unintubated patient with AHRF in PP will improve oxygenation and 
      avoid the need for invasive mechanical ventilation and thereby its complications. 
      Here, we describe a series of 13 patients with hypoxemic respiratory of varied 
      etiology, who were successfully treated in the PP without endotracheal 
      intubation. Two patients (15.4%) had mild, nine (69.2%) had moderate, and two 
      (15.4%) had severe hypoxemia. Oxygenation as assessed by PaO(2)/FiO(2) ratio in 
      supine position was 154 +/- 52, which improved to 328 +/- 65 after PP. Alveolar to 
      arterial (A-a) O(2) gradient improved from a median of 170.5 mm Hg interquartile 
      range (IQR) (127.8, 309.7) in supine position to 49.1 mm Hg IQR (45.0, 56.6) 
      after PP. This improvement in oxygenation took a median of 46 hours, IQR (24, 
      109). Thus, voluntary PP maneuver improved oxygenation and avoided endotracheal 
      intubation in a select group of patients with hypoxemic respiratory failure. This 
      maneuver may be relevant in the ongoing novel coronavirus disease pandemic by 
      potentially reducing endotracheal intubation and the need for ventilator and 
      therefore better utilization of critical care services. HOW TO CITE THIS ARTICLE: 
      Rao SV, Udhayachandar R, Rao VB, Raju NA, Nesaraj JJJ, Kandasamy S, et al. 
      Voluntary Prone Position for Acute Hypoxemic Respiratory Failure in Unintubated 
      Patients. Indian J Crit Care Med 2020;24(7):557-562.
CI  - Copyright (c) 2020; Jaypee Brothers Medical Publishers (P) Ltd.
FAU - Rao, Shoma V
AU  - Rao SV
AD  - Surgical ICU, Division of Critical Care, Christian Medical College, Vellore, 
      Tamil Nadu, India.
FAU - Udhayachandar, R
AU  - Udhayachandar R
AD  - Surgical ICU, Division of Critical Care, Christian Medical College, Vellore, 
      Tamil Nadu, India.
FAU - Rao, Vasudha B
AU  - Rao VB
AD  - Critical Care Unit, Department of Medicine, Launceston General Hospital, 
      Launceston, Tasmania, Australia.
FAU - Raju, Nithin A
AU  - Raju NA
AD  - Critical Care Unit, Department of Medicine, Launceston General Hospital, 
      Launceston, Tasmania, Australia.
FAU - Nesaraj, Juliana Jj
AU  - Nesaraj JJ
AD  - Critical Care Unit, Department of Medicine, Launceston General Hospital, 
      Launceston, Tasmania, Australia.
FAU - Kandasamy, Subramani
AU  - Kandasamy S
AD  - Surgical ICU, Division of Critical Care, Christian Medical College, Vellore, 
      Tamil Nadu, India.
FAU - Samuel, Prasanna
AU  - Samuel P
AD  - Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, 
      India.
LA  - eng
PT  - Journal Article
PL  - India
TA  - Indian J Crit Care Med
JT  - Indian journal of critical care medicine : peer-reviewed, official publication of 
      Indian Society of Critical Care Medicine
JID - 101208863
PMC - PMC7482355
OTO - NOTNLM
OT  - Acute hypoxemic respiratory failure
OT  - Acute respiratory distress syndrome
OT  - Awake
OT  - Awake prone
OT  - COVID-19
OT  - Unintubated
OT  - Voluntary prone
COIS- Source of support: Nil Conflict of interest: None
EDAT- 2020/09/24 06:00
MHDA- 2020/09/24 06:01
PMCR- 2020/07/01
CRDT- 2020/09/23 06:33
PHST- 2020/09/23 06:33 [entrez]
PHST- 2020/09/24 06:00 [pubmed]
PHST- 2020/09/24 06:01 [medline]
PHST- 2020/07/01 00:00 [pmc-release]
AID - 10.5005/jp-journals-10071-23495 [doi]
PST - ppublish
SO  - Indian J Crit Care Med. 2020 Jul;24(7):557-562. doi: 
      10.5005/jp-journals-10071-23495.