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Stilma W, Åkerman E, Artigas A, et al. 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. Am J Trop Med Hyg. 2021;doi: 10.4269/ajtmh.20-1445.
Stilma, W., Åkerman, E., Artigas, A., Bentley, A., Bos, L. D., Bosman, T. J. C., de Bruin, H., Brummaier, T., Buiteman-Kruizinga, L. A., Carcò, F., Chesney, G., Chu, C., Dark, P., Dondorp, A. M., Gijsbers, H. J. H., Gilder, M. E., Grieco, D. L., Inglis, R., Laffey, J. G., Landoni, G., Lu, W., Maduro, L. M. N., McGready, R., McNicholas, B., de Mendoza, D., Morales-Quinteros, L., Nosten, F., Papali, A., Paternoster, G., Paulus, F., Pisani, L., Prud'homme, E., Ricard, J. D., Roca, O., Sartini, C., Scaravilli, V., Schultz, M. J., Sivakorn, C., Spronk, P. E., Sztajnbok, J., Trigui, Y., Vollman, K. M., & van der Woude, M. C. E. (2021). 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. The American journal of tropical medicine and hygiene, . https://doi.org/10.4269/ajtmh.20-1445
Stilma, Willemke, et al. "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." The American journal of tropical medicine and hygiene vol. (2021). doi: https://doi.org/10.4269/ajtmh.20-1445
Stilma W, Åkerman E, Artigas A, Bentley A, Bos LD, Bosman TJC, de Bruin H, Brummaier T, Buiteman-Kruizinga LA, Carcò F, Chesney G, Chu C, Dark P, Dondorp AM, Gijsbers HJH, Gilder ME, Grieco DL, Inglis R, Laffey JG, Landoni G, Lu W, Maduro LMN, McGready R, McNicholas B, de Mendoza D, Morales-Quinteros L, Nosten F, Papali A, Paternoster G, Paulus F, Pisani L, Prud'homme E, Ricard JD, Roca O, Sartini C, Scaravilli V, Schultz MJ, Sivakorn C, Spronk PE, Sztajnbok J, Trigui Y, Vollman KM, van der Woude MCE. 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. Am J Trop Med Hyg. 2021 Mar 11; doi: 10.4269/ajtmh.20-1445. Epub 2021 Mar 11. PMID: 33705348; PMCID: PMC8103477.
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Am J Trop Med Hyg. 2021 Mar 11; doi: 10.4269/ajtmh.20-1445. Epub 2021 Mar 11.

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.

The American journal of tropical medicine and hygiene

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

Affiliations

  1. 1Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.
  2. 2Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Science, Amsterdam, The Netherlands.
  3. 3Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
  4. 4Function of Perioperative Medicine and Intensive Care, Department of Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
  5. 5Department of Intensive Care, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Sabadell, Barcelona, Spain.
  6. 6Autonomous University of Barcelona, Sabadell, Barcelona, Spain.
  7. 7Acute Intensive Care Unit, Manchester University NHS Foundation, Manchester, United Kingdom.
  8. 8Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
  9. 9Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
  10. 10Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
  11. 11Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands.
  12. 12Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  13. 13Division of Emergency Medicine-Critical Care, Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York.
  14. 14Critical Care Medicine, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom.
  15. 15Division of Infection, Immunity and Respiratory Medicine, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom.
  16. 16Humanitarian and Conflict Response Institute, University of Manchester, Manchester, United Kingdom.
  17. 17Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.
  18. 18Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.
  19. 19Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
  20. 20Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  21. 21Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy.
  22. 22Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, University of Oxford, Vientiane, Lao People's Democratic Republic.
  23. 23Department of Anaesthesia and Intensive Care, MedicineGalway University Hospitals, Galway, Ireland.
  24. 24School of Medicine, Disciplines of Anaesthesia and Intensive Care Medicine, National University of Ireland, Galway, Ireland.
  25. 25School of Medicine, Vita Salute San Raffaele University, Milan, Italy.
  26. 26Department of Critical Care Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, China.
  27. 27Intensive Care Department, Hospital Universitari Sagrat Cor. Grupo Quironsalud, Barcelona, Spain.
  28. 28Emergency Department, Hospital Universitari Sagrat Cor. Grupo Quironsalud, Barcelona, Spain.
  29. 29Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
  30. 30Institut d' Investigacio I Innovacio Parc Taulí I3PT, Universidad Autonoma de Barcelona, Barcelona, Spain.
  31. 31Division of Pulmonary and Critical Medicine, Atrium Health, Charlotte, North Carolina.
  32. 32School of Medicine, University of Maryland, Baltimore, Maryland.
  33. 33Department of Cardiovascular Anaesthesia and ICU, San Carlo Hospital, Potenza, Italy.
  34. 34Section of Operational Research, Doctors with Africa CUAMM, Padova, Italy.
  35. 35Intensive Care Unit, Détresse Respiratoire Infections Sévères, Assistance Publique Hôpitaux de Marseille, Marseille, France.
  36. 36DMU ESPRIT-Enseignements et Soins de Proximité, Recherche, Innovation et Territoires, Université de Paris, Paris, France.
  37. 37Infection, Antimicrobiens, Modélisation, Evolution (IAME), Université de Paris, Paris, France.
  38. 38Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique - Hôpitaux de Paris, Colombes, France.
  39. 39Servei de Medicina Intensiva, Hospital Vall d'Hebron, Barcelona, Spain.
  40. 40Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
  41. 41Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand.
  42. 42Expertise Center for Intensive Care Rehabilitation Apeldoorn, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands.
  43. 43Intensive Care Unit, Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.
  44. 44Service des Maladies Respiratoires, Centre Hospitalier D'Aix-en-Provence, Aix-en-Provence, France.
  45. 45Clinical Nurse Specialist/Critical Care Consultant, Advancing Nursing LLC, Northville, Michigan.
  46. 46Intensive Care Unit, Zuyderland Medisch Centrum, Location 'Heerlen', Heerlen, The Netherlands.

PMID: 33705348 PMCID: PMC8103477 DOI: 10.4269/ajtmh.20-1445

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. A growing 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.

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