PMID- 34301802
OWN - NLM
STAT- MEDLINE
DCOM- 20211122
LR  - 20230322
IS  - 1943-3654 (Electronic)
IS  - 0020-1324 (Linking)
VI  - 66
IP  - 12
DP  - 2021 Dec
TI  - Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS.
PG  - 1898-1911
LID - 10.4187/respcare.09194 [doi]
AB  - 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.
CI  - Copyright (c) 2021 by Daedalus Enterprises.
FAU - Gonzalez-Seguel, Felipe
AU  - Gonzalez-Seguel F
AD  - Servicio de Medicina Fisica y Rehabilitacion and Departamento de Paciente 
      Critico, Clinica Alemana Universidad del Desarrollo, Santiago, Chile. 
      feligonzalezs@udd.cl.
AD  - Master Program in Physical Therapy and Rehabilitation, School of Physical 
      Therapy, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, 
      Santiago, Chile.
FAU - Pinto-Concha, Juan Jose
AU  - Pinto-Concha JJ
AD  - Master Program in Physical Therapy and Rehabilitation, School of Physical 
      Therapy, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, 
      Santiago, Chile.
AD  - Centro de Paciente Critico Adulto, Clinica INDISA, Santiago, Chile.
FAU - Aranis, Nadine
AU  - Aranis N
AD  - Servicio de Medicina Fisica y Rehabilitacion and Departamento de Paciente 
      Critico, Clinica Alemana Universidad del Desarrollo, Santiago, Chile.
AD  - Master Program in Physical Therapy and Rehabilitation, School of Physical 
      Therapy, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, 
      Santiago, Chile.
FAU - Leppe, Jaime
AU  - Leppe J
AD  - Master Program in Physical Therapy and Rehabilitation, School of Physical 
      Therapy, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, 
      Santiago, Chile.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20210723
PL  - United States
TA  - Respir Care
JT  - Respiratory care
JID - 7510357
SB  - IM
MH  - Adult
MH  - *COVID-19
MH  - Humans
MH  - Patient Positioning
MH  - Prone Position
MH  - Respiration, Artificial/adverse effects
MH  - *Respiratory Distress Syndrome/etiology/therapy
MH  - SARS-CoV-2
OTO - NOTNLM
OT  - ARDS
OT  - adverse events
OT  - complications
OT  - mechanical ventilation
OT  - prone position
OT  - respiratory failure
COIS- The authors have no conflicts to disclose.
EDAT- 2021/07/25 06:00
MHDA- 2021/11/23 06:00
CRDT- 2021/07/24 05:40
PHST- 2021/07/25 06:00 [pubmed]
PHST- 2021/11/23 06:00 [medline]
PHST- 2021/07/24 05:40 [entrez]
AID - respcare.09194 [pii]
AID - 10.4187/respcare.09194 [doi]
PST - ppublish
SO  - Respir Care. 2021 Dec;66(12):1898-1911. doi: 10.4187/respcare.09194. Epub 2021 
      Jul 23.