FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3042390416> ?p ?o ?g. }

• W3042390416 endingPage "2435" @default.
• W3042390416 startingPage "2431" @default.
• W3042390416 abstract "Patients with coronavirus disease 2019 (COVID-19) pneumonia can experience the development of hypoxemic acute respiratory failure (hARF) that might require the application of a positive end-expiratory pressure (PEEP).1Huang C. Wang Y. Li X. et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; 395: 497-506Abstract Full Text Full Text PDF PubMed Scopus (30327) Google Scholar Noninvasive CPAP improves oxygenation and reduces the need for endotracheal intubation in comparison with standard oxygen therapy in patients with severe hARF due to pneumonia.2Cosentini R. Brambilla A.M. Aliberti S. et al.Helmet continous positive airway pressure vs oxygen therapy to improve oxygentaion in community-acquires pneumonia: a randomized controlled trial.Chest. 2010; 138: 114-120Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar,3Brambilla A.M. Aliberti S. Prina E. et al.Helmet CPAP vs oxygen therapy in severe hypoxemic respiratory failure due to pneumonia.Intensive Care Med. 2014; 40: 942-949Crossref PubMed Scopus (123) Google Scholar During CPAP treatment, patients with hARF might also benefit of additional interventions, such as prone positioning.4Gattinoni L. Busana M. Giosa L. Macrì M.M. Quintel M. Prone positioning in acute respiratory distress syndrome.Semin Respir Crit Care Med. 2019; 40: 94-100Crossref PubMed Scopus (69) Google Scholar Pronation of awake, spontaneously breathing, nonintubated patients with hARF is feasible, safe, and associated with a significant benefit on oxygenation.5Scaravilli V. Grasselli G. Castagna L. et al.Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: a retrospective study.J Crit Care. 2015; 30: 1390-1394Crossref PubMed Scopus (168) Google Scholar,6Ding L. Wang L. Ma W. He H. Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-center prospective cohort study.Crit Care. 2020; 24: 28Crossref PubMed Scopus (248) Google Scholar Lateral position may be also associated with beneficial effects on gas exchange, especially in unilateral widespread infiltrates.7Hewitt N. Bucknall T. Faraone N.M. Lateral positioning for critically ill adult patients.Cochrane Database Syst Rev. 2016; : CD007205PubMed Google Scholar Finally, a recent experience demonstrated that awake, early self-proning improves oxygen saturation in patients with COVID-19.8Caputo N.D. Strayer R.J. Levitan R. Early self-proning in awake, non-intubated patients in the emergency department: a single ED’s experience during the COVID-19 pandemic.Acad Emerg Med. 2020; 27: 375-378Crossref PubMed Scopus (229) Google Scholar The objective of this study was to evaluate the efficacy of both prone and lateral positioning in patients who undergo helmet CPAP because of hARF that is caused by COVID-19 pneumonia. A pilot, observational, prospective study was conducted at the COVID-19 respiratory high-dependency unit (HDU) of the Policlinico Hospital in Milan, Italy, between March and April 2020. The respiratory HDU is characterized by a nurse:patient ratio per shift of 1:4, multivariable monitors, noninvasive ventilators, and life support, on-site intubation and invasive ventilation, attending physicians available 24 hours 7 days a week, and bronchoscopy and arterial blood gas analysis inside the unit.9Scala R. Corrado A. Confalonieri M. Marchese S. Ambrosino N. Scientific Group on Respiratory Intensive Care of the Italian Association of Hospital PneumologistsIncreased number and expertise of Italian respiratory high-dependency care units: the second national survey.Respir Care. 2011; 56: 1100-1107Crossref PubMed Scopus (49) Google Scholar Consecutively recruited adults (≥18 years old) with hARF caused by laboratory-confirmed COVID-19 pneumonia who were undergoing helmet CPAP treatment were included in this study. All patients who were undergoing helmet CPAP had a Glasgow Coma Scale of 15 and were spontaneously breathing and not intubated. The Institutional Review Board of the Policlinico hospital approved the study (#345_2020). Patients with at least one of the following criteria were excluded: need for immediate intubation, Glasgow Coma Scale <15, systolic BP (SBP) < 90 mm Hg, and SpO2 <90% at Fio2 >0.8. Patients underwent either prone or lateral positioning according to standard operating procedures and the last chest radiograph or chest CT scan. A trial of prone/lateral position was started as an intervention in patients with COVID-19 who were undergoing helmet CPAP if their Pao2:Fio2 ratio that had been evaluated during helmet CPAP treatment was persistently <250 after at least 48 hours. Lateral position was performed when lung impairment was mainly monolateral, with the lung with no or less involvement placed down, whereas prone position was adopted when lung impairment was bilateral (Fig 1A, B).10Yeaw E.M. How position affects oxygenation. Good lung down?.Am J Nurs. 1992; 92: 26-29PubMed Google Scholar Prone/lateral position lasted 1 hour. Levels of both PEEP and Fio2 did not change during the trial and were selected as per clinical indication. Vital parameters and blood gas analysis were recorded at three time points: before the trial with the patient in a semi-seated position (T0), after 1 hour from trial initiation with the patient in prone/lateral position (T1), and 45 minutes after the trial with the patient returned to a semi-seated position (T2). The primary outcome was the success of the prone/lateral positioning trial, defined as the occurrence of all of the following criteria at T1 in comparison with T0: (1) a decrease of the alveolar–arterial gradient (A-ao2) of at least 20%, (2) equal or reduced respiratory rate, (3) equal or reduced dyspnea (evaluated through the BORG scale), and (4) SBP ≥90 mm Hg. Trial failure was defined as the occurrence of at least one of the following criteria during the test: (1) an unchanged or increased A-ao2; (2) an increased respiratory rate, (3) a decrease of SBP <90 mm Hg, (4) a SpO2 <90%, (5) occurrence of respiratory distress, and (6) occurrence of patient’s discomfort.Qualitative variables were described with absolute and relative (percentage) frequencies, whereas quantitative variables were summarized with means (SD) or medians (interquartile ranges [IQR]) in the case of parametric or nonparametric distribution, respectively. Analysis of variance and Friedman tests were used to detect any statistical differences in the comparison of normal and nonnormal vital and blood gas analysis parameters during different time points. A two-tailed probability value of <.05 was considered statistically significant. The statistical software STATA (version 16; (StataCorp, College Station, TX) was used to perform all statistical computations. A total of 26 patients (67% male; median age: 62 year [IQR, 56-69 years] were included. The most prevalent comorbidities were systemic hypertension (43%), diabetes mellitus (21%), obesity (14%), COPD (11%), and asthma (11%). On HDU admission, the median PaO2:FiO2 ratio on oxygen therapy delivered through Venturi mask was 143 (IQR, 97-204); the A-ao2 was 269 mm Hg (IQR, 144-540 mm Hg), and the respiratory rate was 27 breaths/min (IQR, 22-31 breaths/min). All patients had hARF that was caused by COVID-19 pneumonia and who underwent helmet CPAP with a median Pao2:Fio2 ratio of 180 (IQR, 155-218) and A-ao2 of 207 (156-262). A total of 39 tests (12 prone and 27 lateral positioning) were conducted after a median time from symptoms onset of 14 days (IQR, 10-17 days) and of 4 days (IQR, 2-7 days) from HDU admission. All tests but two (both in lateral positioning due to patient discomfort) were carried out. Changing of vital parameters and blood gas analysis values before, during, and after the test are reported in Table 1 and Figure 1C for all patients who completed the trial. In terms of primary end point, 6 trials (15.4%) were successful with a decrease of A-ao2 of 20% during the trial or more in comparison with baseline. Three trials (7.7%) showed a A-ao2 decrease of at least 30% in comparison with baseline values. Seventeen trials (46.1%) showed a decrease of <20% of A-ao2. A total of 15 trials (38.5%) failed: one patient (2.6%) experienced a decrease of SBP (<90 mm Hg); two patients experienced discomfort (5.1%); three patients (7.7%) had an increase in respiratory rate, and nine patients (23.1%) had an increase of A-ao2. Among trials conducted in prone positioning, 33.3% succeeded; 41.7% showed a decreased A-ao2 (<20%), whereas 25% failed. Among trials conducted in lateral positioning, 8% succeeded; 52% showed a decrease of A-ao2 (<20%), while 40% failed. Improved gas exchange that was achieved during the trial reverted, returning to the semiseated position (Table 1). Seven of 26 patients (26.9%) underwent intubation and were mechanically ventilated; two patients (7.7%) died.Table 1Changes in Vital Parameters and Blood Gas Analysis Before the Test, After One Hour During the Test, and After the Test in the Overall Study Population and Among Those Who Underwent Either Prone or Lateral PositioningVariableBefore the TestDuring the TestAfter the TestP ValueaBefore the test vs after one hour during the test.P ValuebAmong the three groups.Overall population VitalsSystolic BP, mean (SD), mm Hg124.4 (18.8)122.7 (16.8)123.0 (13.9)1.00.89Diastolic BP, mean (SD), mm Hg73.7 (12.4)71.8 (11.9)72.9 (9.5)1.00.77Heart rate, mean (SD), beats/min75.4 (12.6)77.2 (12.2)72.5 (15.1)1.00.32Respiratory rate, mean (SD), beats/min23.7 (4.7)23.1 (4.5)23.6 (4.7)1.00.80SpO2, median (IQR), %96 (95-98)98 (97-98)97 (95-98)< .0001< .0001 Blood gas analysispH, mean (SD)7.45 (0.03)7.45 (0.02)7.45 (0.03)1.00.69Paco2, median (IQR), mm Hg38 (35-40)38 (35-39)38 (35-40).69.36Pao2, mean (SD), mm Hg86.9 (15.1)104.5 (25.0)85.4 (13.4)<.0001<.0001Pao2:Fio2 ratio, mean (SD)182.9 (43.0)220.0 (64.5)179.3 (43.9).008.002A-ao2, median (IQR), mm Hg207.1 (160.7-251.3)184.3 (141.4-246.8)209.5 (153.5-282.3).0002.0002Prone positioning (n = 12) VitalsSystolic BP, mean (SD), mm Hg122.8 (13.3)124.3 (14.9)125 (12.7)1.00.92Diastolic BP, mean (SD), mm Hg72.3 (10.1)72.7 (11.7)73.6 (8.8)1.00.95Heart rate, mean (SD), beats/min76.6 (14.2)76.9 (11.7)71.6 (13.6)1.00.56Respiratory rate, mean (SD), beats/min23.5 (6.3)21.3 (5.0)22.9 (6.0)1.00.62SpO2, median (IQR), %95 (93.5-96.0)98 (98-99)96 (95-98)< .0001< .0001 Blood gas analysispH, mean (SD)7.46 (0.02)7.46 (0.02)7.45 (0.04)1.00.77Paco2, median (IQR), mm Hg39 (35.5-40.5)38 (34.5-41.0)37 (35-41)1.00.74Pao2, mean (SD), mm Hg83.6 (14.2)112.3 (32.3)85.6 (11.5).008.004Pao2:Fio2 ratio, mean (SD)168.7 (46.2)227.7 (90.3)166.9 (45.3).10.046A-ao2, median (IQR)219.3 (183.2-279.8)193.1 (132.3-281.2)229.3 (173.6-292.8).03.02Lateral positioning (n = 25) VitalsSystolic BP, mean (SD), mm Hg125.2 (21.2)121.9 (17.9)122 (14.6)1.00.77Diastolic BP, mean (SD), mm Hg74.4 (13.5)71.4 (12.3)72.5 (9.9)1.00.67Heart rate, mean (SD), beats/min74.8 (12.0)77.4 (12.7)72.9 (16.0)1.00.53Respiratory rate, mean (SD), beats/min23.8 (.9)23.9 (4.0)24.0 (4.1)1.001.00SpO2, median (IQR), %97 (96-98)98 (96-98)97 (96-98).03.09 Blood gas analysispH, mean (SD)7.46 (0.03)7.45 (0.02)7.45 (0.02)1.00.88Paco2, median (IQR), mm Hg38 (34-39)37 (35-39)38 (35-40).62.07Pao2, mean (SD), mm Hg88.4 (15.5)100.8 (20.4)85.8 (14.5).04.006Pao2:Fio2 ratio, mean (SD)189.7 (40.6)216.2 (49.6)185.0 (43.0.11.04A-ao2, median (IQR)198.8 (151.7-227.8)182.8 (142.0-213.8)199 (153.3-260.6).003.007IQR = interquartile range; SpO2 = blood oxygen saturation level.a Before the test vs after one hour during the test.b Among the three groups. Open table in a new tab IQR = interquartile range; SpO2 = blood oxygen saturation level. The main study findings were (1) that only a small proportion of prone/lateral positioning tests conducted in patients with COVID-19 on helmet CPAP therapy succeeded (significant improvement of gas exchange), (2) that the decrease of the A-ao2 was <20% (minimum clinically relevant important difference), (3) that there was a higher success rate in prone positioning vs lateral positioning, and (4) that the improved gas exchange changed when the patient returned to the semi-seated position. The A-ao2 gradient was adopted as the end point because of the COVID-19 pneumonia-related hARF. A-ao2 gradient can better assess gas exchange dysfunction in comparison with Pao2:Fio2 ratio being patients hypocapnic. The 20% threshold for A-ao2 gradient decrease as a component of the primary outcome was chosen arbitrarily by the study team after consensus that considered previously published literature on prone positioning.11Guérin C. Reignier J. Richard J.C. et al.Prone positioning in severe acute respiratory distress syndrome.N Engl J Med. 2013; 368: 2159-2168Crossref PubMed Scopus (2460) Google Scholar Notably, from 25% (prone positioning) to 40% (lateral positioning) of the tests failed, because of an increase of respiratory rate or A-ao2. Physicians should be aware of strict monitoring by expert respiratory physiotherapists or nurses during prone/lateral positioning. The relatively high failure rate might be related mainly to the complex pathophysiology of respiratory failure in patients with COVID-19, where diffuse alveolar damage (like in “classic” ARDS) and diffuse endothelial damage that leads to pulmonary intravascular coagulopathy with disseminated microthrombosis were found. This study has several limitations. First, it was designed as a “purely physiologic” study, without assessment of the potential impact of prone/lateral positioning on clinical outcomes or confounders, such as setting (eg, Fio2 and PEEP) and length of CPAP treatment before the trial. Further randomized controlled trials are needed to evaluate the efficacy of prone/lateral positioning on both intubation and mortality rate. Second, we evaluated both response and tolerance only after one hour since test initiation. Different studies showed that a positive response of patients with ARDS can be recorded several hours after having turned the patient prone and that long-term information about tolerance and compliance to prone positioning are needed because they might impact clinical outcomes. This is the first experience of prone/lateral positioning in awake, spontaneously breathing patients with COVID-19 who were treated with helmet CPAP. Our results could help design multicenter randomized controlled trials on prone/lateral positioning in nonintubated patients with COVID-19. Other contributions: The authors would like to acknowledge the support of all the pulmonologists, nurses and respiratory physiotherapists of the COVID-19 HDU of the Policlinico Hospital, Milan, Italy. Insights About Prone and Lateral Positioning in Spontaneously Breathing Patients With COVID-19 Pneumonia Undergoing Noninvasive Helmet CPAP TreatmentCHESTVol. 159Issue 6PreviewThe work by Retucci et al1 in CHEST (December 2020) about the change of position during spontaneous breathing and COVID-19 pneumonia with ratio of arterial oxygen partial pressure to fractional inspired oxygen less than 250 is very interesting. A shift in position (prone or lateral), in the first 2 hours of treatment, is the principal mechanism of action in the recruitment of lung tissue, especially during noninvasive helmet CPAP. In their study, the association between CPAP use and the radiologic pattern (particularly GGO prevalence or consolidation) is not obvious. Full-Text PDF ResponseCHESTVol. 159Issue 6PreviewWe thank Dr Fiorentino and coworkers for their interest in our recently published experience on prone and lateral positioning in spontaneously breathing patients with COVID-19 pneumonia undergoing noninvasive helmet CPAP treatment.1 Noninvasive ventilation (NIV) and noninvasive CPAP have been extensively used during the COVID-19 pandemic, as documented by several observational studies published over the past few months, although no randomized controlled studies have been designed to investigate their safety and efficacy in this specific population. Full-Text PDF" @default.
• W3042390416 created "2020-07-23" @default.
• W3042390416 creator A5002029403 @default.
• W3042390416 creator A5004487731 @default.
• W3042390416 creator A5019495239 @default.
• W3042390416 creator A5025196688 @default.
• W3042390416 creator A5029931649 @default.
• W3042390416 creator A5058412528 @default.
• W3042390416 creator A5063078489 @default.
• W3042390416 creator A5066917057 @default.
• W3042390416 creator A5068491669 @default.
• W3042390416 creator A5071689481 @default.
• W3042390416 creator A5071827015 @default.
• W3042390416 creator A5088693297 @default.
• W3042390416 creator A5089207576 @default.
• W3042390416 date "2020-12-01" @default.
• W3042390416 modified "2023-10-11" @default.
• W3042390416 title "Prone and Lateral Positioning in Spontaneously Breathing Patients With COVID-19 Pneumonia Undergoing Noninvasive Helmet CPAP Treatment" @default.
• W3042390416 cites W2068178744 @default.
• W3042390416 cites W2106923828 @default.
• W3042390416 cites W2118860030 @default.
• W3042390416 cites W2128472822 @default.
• W3042390416 cites W2137716271 @default.
• W3042390416 cites W2944594285 @default.
• W3042390416 cites W3001118548 @default.
• W3042390416 cites W3010960510 @default.
• W3042390416 cites W3016531041 @default.
• W3042390416 doi "https://doi.org/10.1016/j.chest.2020.07.006" @default.
• W3042390416 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/7361047" @default.
• W3042390416 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/32679237" @default.
• W3042390416 hasPublicationYear "2020" @default.
• W3042390416 type Work @default.
• W3042390416 sameAs 3042390416 @default.
• W3042390416 citedByCount "54" @default.
• W3042390416 countsByYear W30423904162020 @default.
• W3042390416 countsByYear W30423904162021 @default.
• W3042390416 countsByYear W30423904162022 @default.
• W3042390416 countsByYear W30423904162023 @default.
• W3042390416 crossrefType "journal-article" @default.
• W3042390416 hasAuthorship W3042390416A5002029403 @default.
• W3042390416 hasAuthorship W3042390416A5004487731 @default.
• W3042390416 hasAuthorship W3042390416A5019495239 @default.
• W3042390416 hasAuthorship W3042390416A5025196688 @default.
• W3042390416 hasAuthorship W3042390416A5029931649 @default.
• W3042390416 hasAuthorship W3042390416A5058412528 @default.
• W3042390416 hasAuthorship W3042390416A5063078489 @default.
• W3042390416 hasAuthorship W3042390416A5066917057 @default.
• W3042390416 hasAuthorship W3042390416A5068491669 @default.
• W3042390416 hasAuthorship W3042390416A5071689481 @default.
• W3042390416 hasAuthorship W3042390416A5071827015 @default.
• W3042390416 hasAuthorship W3042390416A5088693297 @default.
• W3042390416 hasAuthorship W3042390416A5089207576 @default.
• W3042390416 hasBestOaLocation W30423904161 @default.
• W3042390416 hasConcept C116675565 @default.
• W3042390416 hasConcept C126322002 @default.
• W3042390416 hasConcept C142724271 @default.
• W3042390416 hasConcept C163100246 @default.
• W3042390416 hasConcept C177713679 @default.
• W3042390416 hasConcept C2776006263 @default.
• W3042390416 hasConcept C2777914695 @default.
• W3042390416 hasConcept C2779134260 @default.
• W3042390416 hasConcept C2779547634 @default.
• W3042390416 hasConcept C3006700255 @default.
• W3042390416 hasConcept C3007834351 @default.
• W3042390416 hasConcept C3008058167 @default.
• W3042390416 hasConcept C39300077 @default.
• W3042390416 hasConcept C42219234 @default.
• W3042390416 hasConcept C524204448 @default.
• W3042390416 hasConcept C71924100 @default.
• W3042390416 hasConceptScore W3042390416C116675565 @default.
• W3042390416 hasConceptScore W3042390416C126322002 @default.
• W3042390416 hasConceptScore W3042390416C142724271 @default.
• W3042390416 hasConceptScore W3042390416C163100246 @default.
• W3042390416 hasConceptScore W3042390416C177713679 @default.
• W3042390416 hasConceptScore W3042390416C2776006263 @default.
• W3042390416 hasConceptScore W3042390416C2777914695 @default.
• W3042390416 hasConceptScore W3042390416C2779134260 @default.
• W3042390416 hasConceptScore W3042390416C2779547634 @default.
• W3042390416 hasConceptScore W3042390416C3006700255 @default.
• W3042390416 hasConceptScore W3042390416C3007834351 @default.
• W3042390416 hasConceptScore W3042390416C3008058167 @default.
• W3042390416 hasConceptScore W3042390416C39300077 @default.
• W3042390416 hasConceptScore W3042390416C42219234 @default.
• W3042390416 hasConceptScore W3042390416C524204448 @default.
• W3042390416 hasConceptScore W3042390416C71924100 @default.
• W3042390416 hasIssue "6" @default.
• W3042390416 hasLocation W30423904161 @default.
• W3042390416 hasLocation W30423904162 @default.
• W3042390416 hasLocation W30423904163 @default.
• W3042390416 hasLocation W30423904164 @default.
• W3042390416 hasOpenAccess W3042390416 @default.
• W3042390416 hasPrimaryLocation W30423904161 @default.
• W3042390416 hasRelatedWork W2104334748 @default.
• W3042390416 hasRelatedWork W2123366884 @default.
• W3042390416 hasRelatedWork W2130931636 @default.
• W3042390416 hasRelatedWork W2137169928 @default.
• W3042390416 hasRelatedWork W2473826360 @default.
• W3042390416 hasRelatedWork W3206842824 @default.

• next