Evaluación de la respuesta a la posición prono en pacientes despiertos hospitalizados con COVID-19
DOI:
https://doi.org/10.1590/1809-2950/21018529012022PTPalabras clave:
COVID-19, Coronavirus, Posición Prona, Intubación, Unidades de Cuidados Intensivos.Resumen
El propósito de este estudio fue evaluar los efectos agudos de los tipos de respuesta a la posición prona (PP) en los pacientes despiertos hospitalizados por COVID-19. Se realizó un estudio prospectivo, unicéntrico, con la participación de 32 pacientes hospitalizados por COVID-19 y con el uso de oxígeno suplementario. La respuesta a la posición prono se realizó durante 30 minutos. Después de la prueba, se orientó que los pacientes permanezcan en la PP diariamente según su tolerancia. Se registraron las variables saturación de oxígeno (SpO2), frecuencia cardiaca, frecuencia respiratoria, índice ROX y tasa de ingreso a la unidad de cuidados intensivos (UCI). Un total de 25 pacientes (78,1%) respondieron a la PP, de los cuales 13 (40,6%) tuvieron respuesta persistente y 12 (37,5%) presentaron respuesta transitoria. Siete pacientes (21,9%) no respondieron. Los pacientes con respuestas persistentes y transitorias presentaron un incremento de la SpO2 (p<0,001) y el índice ROX (p=0,001 y p<0,001, respectivamente), y una reducción de las frecuencias cardiaca (p=0,01 y p=0,02, respectivamente) y respiratoria (p=0,003 y p=0,001, respectivamente). No hubo diferencia en ninguna de las variables en los pacientes que no respondieron a la PP. La tasa de ingreso en la UCI de pacientes que tuvieron una respuesta persistente, transitoria o que no respondieron a la PP fue de un 30,8% (4/13), un 41,7% (5/12) y un 57,1% (4/7), respectivamente. Se concluye que los pacientes que respondieron a la PP tuvieron una reducción de las frecuencias cardiaca y respiratoria, incremento del índice ROX, sin interferir en la tasa de hospitalización
Descargas
Referencias
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA [Internet]. 2020 May 26;323(20):2052–9. Available from: http://dx.doi.org/10.1001/jama.2020.6775
Sztajnbok J, Maselli-Schoueri JH, Cunha de Resende Brasil LM, Farias de Sousa L, Cordeiro CM, Sansão Borges LM, et al. Prone positioning to improve oxygenation and relieve respiratory symptoms in awake, spontaneously breathing non-intubated patients with COVID-19 pneumonia. Respir Med Case Rep [Internet]. 2020 May 19;30:101096. Available from: http://dx.doi.org/10.1016/j.rmcr.2020.101096
Albert RK, Hubmayr RD. The prone position eliminates compression of the lungs by the heart. Am J Respir Crit Care Med [Internet]. 2000 May;161(5):1660–5. Available from: http://dx.doi.org/10.1164/ajrccm.161.5.9901037
Guérin C, Reignier J, Richard J-C, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med [Internet]. 2013 Jun 6;368(23):2159–68. Available from: http://dx.doi.org/10.1056/NEJMoa1214103
Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med [Internet]. 2020 Jun;48(6):e440–69. Available from: http://dx.doi.org/10.1097/CCM.0000000000004363
Jiang LG, LeBaron J, Bodnar D, Caputo ND, Chang BP, Chiricolo G, et al. Conscious Proning: An Introduction of a Proning Protocol for Nonintubated, Awake, Hypoxic Emergency Department COVID-19 Patients. Acad Emerg Med [Internet]. 2020 Jul;27(7):566–9. Available from: http://dx.doi.org/10.1111/acem.14035
Ding 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 [Internet]. 2020 Jan 30;24(1):28. Available from: http://dx.doi.org/10.1186/s13054-020-2738-5
Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Respir Med [Internet]. 2020 Aug;8(8):765–74. Available from: http://dx.doi.org/10.1016/S2213-2600(20)30268-X
Ng Z, Tay WC, Ho CHB. Awake prone positioning for non-intubated oxygen dependent COVID-19 pneumonia patients. Eur Respir J [Internet]. 2020 Jul;56(1). Available from: http://dx.doi.org/10.1183/13993003.01198-2020
Hopkins SR, Henderson AC, Levin DL, Yamada K, Arai T, Buxton RB, et al. Vertical gradients in regional lung density and perfusion in the supine human lung: the Slinky effect. J Appl Physiol [Internet]. 2007 Jul;103(1):240–8. Available from: http://dx.doi.org/10.1152/japplphysiol.01289.2006
Ferrando C, Mellado-Artigas R, Gea A, Arruti E, Aldecoa C, Adalia R, et al. Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study. Crit Care [Internet]. 2020 Oct 6;24(1):597. Available from: http://dx.doi.org/10.1186/s13054-020-03314-6
Hopkins SR, Henderson AC, Levin DL, Yamada K, Arai T, Buxton RB, et al. Vertical gradients in regional lung density and perfusion in the supine human lung: the Slinky effect. J Appl Physiol [Internet]. 2007 Jul;103(1):240–8. Available from: http://dx.doi.org/10.1152/japplphysiol.01289.2006
Anand S, Baishya M, Singh A, Khanna P. Effect of awake prone positioning in COVID-19 patients- A systematic review. Tren Anaesth Crit Care [Internet]. 2021 Feb;36:17–22. Available from: https://doi.org/10.1016/j.tacc.2020.09.008
Taboada M, Rodríguez N, Riveiro V, Baluja A, Atanassoff PG. Prone positioning in awake non-ICU patients with ARDS caused by COVID-19. Anaesth Crit Care Pain Med [Internet]. 2020 Oct;39(5):581–3. Available from: http://dx.doi.org/10.1016/j.accpm.2020.08.002
Thompson AE, Ranard BL, Wei Y, Jelic S. Prone Positioning in Awake, Nonintubated Patients With COVID-19 Hypoxemic Respiratory Failure. JAMA Intern Med [Internet]. 2020 Jun 17; Available from: http://dx.doi.org/10.1001/jamainternmed.2020.3030
Elharrar X, Trigui Y, Dols A-M, Touchon F, Martinez S, Prud’homme E, et al. Use of Prone Positioning in Nonintubated Patients With COVID-19 and Hypoxemic Acute Respiratory Failure. JAMA [Internet]. 2020 Jun 9;323(22):2336–8. Available from: http://dx.doi.org/10.1001/jama.2020.8255
Cardona S, Downing J, Alfalasi R, Bzhilyanskaya V, Milzman D, Rehan M, et al. Intubation rate of patients with hypoxia due to COVID-19 treated with awake proning: A meta-analysis. Am J Emerg Med [Internet]. 2021 May;43:88–96. Available from: http://dx.doi.org/10.1016/j.ajem.2021.01.058
Telias I, Katira BH, Brochard L. Is the Prone Position Helpful During Spontaneous Breathing in Patients With COVID-19? JAMA [Internet]. 2020 Jun 9;323(22):2265–7. Available from: http://dx.doi.org/10.1001/jama.2020.8539
Weatherald J, Solverson K, Zuege DJ, Loroff N, Fiest KM, Parhar KKS. Awake prone positioning for COVID-19 hypoxemic respiratory failure: A rapid review. J Crit Care [Internet]. 2021 Feb;61:63–70. Available from: http://dx.doi.org/10.1016/j.jcrc.2020.08.018
Roca O, Caralt B, Messika J, Samper M, Sztrymf B, Hernández G, et al. An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy [Internet]. Vol. 199, American Journal of Respiratory and Critical Care Medicine. 2019. p. 1368–76. Available from: http://dx.doi.org/10.1164/rccm.201803-0589oc
Zaboli A, Ausserhofer D, Pfeifer N, Sibilio S, Tezza G, Ciccariello L, et al. The ROX index can be a useful tool for the triage evaluation of COVID-19 patients with dyspnoea. J Adv Nurs [Internet]. 2021 Apr 1; Available from: http://dx.doi.org/10.1111/jan.14848
Winearls S, Swingwood EL, Hardaker CL, Smith AM, Easton FM, Millington KJ, et al. Early conscious prone positioning in patients with COVID-19 receiving continuous positive airway pressure: a retrospective analysis. BMJ Open Respir Res [Internet]. 2020 Sep;7(1). Available from: http://dx.doi.org/10.1136/bmjresp-2020-000711
Panadero C, Abad-Fernández A, Rio-Ramirez MT, Acosta Gutierrez CM, Calderon-Alcala M, Lopez-Riolobos C, et al. High-flow nasal cannula for Acute Respiratory Distress Syndrome (ARDS) due to COVID-19. Multidiscip Respir Med [Internet]. 2020 Jan 28;15(1):693. Available from: http://dx.doi.org/10.4081/mrm.2020.693
Descargas
Publicado
Número
Sección
Licencia
Derechos de autor 2022 Angélica Bologna Raposo, Alice Haniuda Moliterno, João Pedro Lucas Neves Silva, Rafael Varago Fabri, Ana Paula Coelho Figueira Freire, Francia Lopes Pacagnelli
Esta obra está bajo una licencia internacional Creative Commons Atribución-CompartirIgual 4.0.
