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Critically Ill Patients with COVID-19: A Narrative Review on Prone Position

机译：Covid-19的危重患者：倾向于倾向于倾向

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IntroductionProne position is known to improve mortality in patients with acute respiratory distress syndrome (ARDS). The impact of prone position in critically ill patients with coronavirus disease of 2019 (COVID-19) remains to be determined. In this review, we describe the mechanisms of action of prone position, systematically appraise the current experience of prone position in COVID-19 patients, and highlight unique considerations for prone position practices during this pandemic.MethodsFor our systematic review, we searched PubMed, Scopus and EMBASE from January 1, 2020, to April 16, 2020. After completion of our search, we became aware of four relevant publications during article preparation that were published in May and June 2020, and these studies were reviewed for eligibility and inclusion. We included all studies reporting clinical characteristics of patients admitted to the hospital with COVID-19 disease who received respiratory support with high-flow nasal cannula, or noninvasive or mechanical ventilation and reported the use of prone position. The full text of eligible articles was reviewed, and data regarding study design, patient characteristics, interventions and outcomes were extracted.ResultsWe found seven studies (total 1899 patients) describing prone position in COVID-19. Prone position has been increasingly used in non-intubated patients with COVID-19; studies show high tolerance and improvement in oxygenation and lung recruitment. Published studies lacked a description of important clinical outcomes (e.g., mortality, duration of mechanical ventilation).ConclusionsBased on the findings of our review, we recommend prone position in patients with moderate to severe COVID-19 ARDS as per existing guidelines. A trial of prone position should be considered for non-intubated COVID-19 patients with hypoxemic respiratory failure, as long as this does not result in a delay in intubation.
机译：已知引导件位置提高急性呼吸窘迫综合征（ARDS）患者的死亡率。 2019年（Covid-19）的冠状病毒病患者患者患者患者的影响仍有待确定。在本综述中，我们描述了易于职位的行动机制，系统地评估Covid-19患者的当前体验，并突出了这种Pandemic.Methods，我们在Pubmed，Scopus中寻找了易于置位实践的独特考虑因素，我们搜索了PubMed，Scopus。并从2020年1月1日开始，到2020年4月16日。在完成搜索后，我们在2020年5月和6月出版的文章准备期间发现了四项相关出版物，并审查了资格和包容性的这些研究。我们包括所有研究报告患者患者患者的临床特征与Covid-19疾病接受过呼吸障碍物，或者非侵入或机械通风，并报告使用易于的位置。审查了符合条件的文章的全文，提取了有关研究设计，患者特征，干预和结果的数据。培养七项研究（共1899名患者）描述了在Covid-19中的俯卧位。倾向于越来越多地用于非插管患者Covid-19;研究表明氧气和肺募集的高耐受性和改善。已发表的研究缺乏对重要临床结果的描述（例如，机械通风的死亡率，持续时间）。在我们的审查结果上结论，我们建议您根据现有指导方针的中度至严重Covid-19 ARDS的患者倾向于患者。对于未加管的Covid-19患者的缺血性呼吸衰竭患者，应考虑易于置位的试验，只要这不会导致插管延迟。

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