Uso da pronação consciente no manejo respiratório de pacientes com COVID 19: uma revisão literária / Use of conscious pronation in the respiratory management of patients with COVID 19: a literature review

Amanda Faria Simoni Campos, André Gusmão Alvarenga, Giovanna Gonçalves de Souza e Silva, Giovanna Maria Franco, Ingridy Maria Diniz Melo Azevedo

Abstract


O vírus Sars-Cov-2 disseminou-se globalmente ao longo do ano de 2020. Este é propagado através de gotículas respiratórias e partículas aerossolizadas e já infectou cerca de 219 milhões de  pessoas e provocou cerca de 4,5 milhões de mortes em todo o mundo. A pronação tem sido utilizada como estratégia no manejo desses pacientes, visto que podem apresentar pneumonia intersticial e hipoxemia respiratória progressiva. Esse trabalho visa avaliar o uso da pronação consciente no manejo respiratório precoce de pacientes não-intubados acometidos pela SARS-Cov-2, por meio de revisão analítica, com descritores “Coronavirus” e “pronation”, de artigos publicados até o momento no Pubmed. O decúbito ventral promove a redução da distensão alveolar ventral e do colapso alveolar dorsal, o que torna a ventilação mais homogênea e otimiza as trocas gasosas. A pronação espontânea tem sido descrita como benéfica a partir de 3 horas de duração, sendo o tempo de permanência ainda controverso. Esse mecanismo como tratamento precoce da COVID-19 tem tido como resultado a melhora dos níveis de oxigenação, e a potencial redução da taxa de IOT e adiamento da internação em Unidade de Terapia Intensiva. Porém, os resultados ainda são limitados e são necessários estudos mais abrangentes na área.


Keywords


pandemia por covid-19, oxigenação, pronação, ventilação.

References


Ahn DG, Shin HJ, Kim MH, Lee S, Kim HS, Myoung J, et al. Current status of epidemiology, diagnosis, therapeutics, and vaccines for novel coronavirus disease 2019 (COVID-19). Microbiol Biotechnol. 2020; 30(3): p. 313-324.

Li Q, Guan X, Peng W, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N Engl J Med. 2020; 382: p. 1199-1207.

Makic MBF. Prone position of patients with COVID-19 and acute respiratory distress syndrome. J perianesth nurs. 2020; 35(4): p. 437-438.

Liu J, Liu S. The management of coronavirus disease 2019 (COVID‐19). J Med Virol. 2020; 92(9): p. 1484-1490.

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13): p. 1239-1242.

Alhazzani W, Moller 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). Intensive Med Care. 2020; 46 (5): p. 854-857.

Bhatraju PK, Ghassmieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the Seattle region—case series. N Engl J Med. 2020; 382(21): p. 2012-2022.

Raoof S, S Nava, Carpati C, Hill NS. High flow, non-invasive ventilation and awake (non-intubation) proning in patients with COVID-19 with respiratory failure. Chest. 2020 ; 158 (5): p. 1992-2002.

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020; 323(16): p. 1574-1581.

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respir Med. 2020; 8(5): p. 475-481.

Winck JC, Ambrosino N. COVID-19 pandemic and non-invasive respiratory management: every Goliath needs a David. An evidence based evaluation of problems. Pulmonology EPub. 2020; 26(4): p. 213-220.

Garbi M. National Institute for Health and Care Excellence clinical guidelines development principles and processes. Heart BMW Journals 2021; 107(12): p. 949-953.

Price S, Singh S, Ledot S, Bianchi P, Hind M, Tavazzi G, et al. Respiratory management in severe acute respiratory syndrome coronavirus 2 infection. Eur J Acute Cardiovascular Care heart. 2020; 9(3): p. 229-238.

Paul V, Patel S, Royse M, Odish M, Malhotra A, Koenig S. Proning in non-intubated (PINI) in times of COVID-19: case series and a review. J Intensive Care Med. 2020. 35(8): p. 818-824.

Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013; 368(23): p. 2159-2168.

Lindahl SGE. Using the prone position could help to combat the development of fast hypoxia in some patients with COVID‐19. Acha Paediatri. 2020; 109(8): p. 1539-1544.

Venus K, Munshi L, M Fralick. Prone positioning for patients with hypoxic respiratory failure related to COVID-19. CMAJ. 2020; 192(47): p. E1532-E1537.

Koulouras V, Papathanakos G, Papathanakos A, Nakos G. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. World J Crit Care Med. 2016; 5(2): p. 121.

Malhotra A, Kacmarek RMJ, Finlay GUWK. Prone ventilation for adult patients with acute respiratory distress syndrome. Uptodate. 2020.

Lang M, Som A, Mendoza DP, Flores EJ, Reid N, Carey D, et al. Hypoxaemia related to COVID-19: vascular and perfusion abnormalities on dual-energy CT. Lancet Infect Dis. 2020; 20(12): p. 1365-1366.

Ciceri F, Beretta L, Scandroglio AM, Colombo S, Landoni G, Ruggeri A, et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc. 2020; 22(2): p. 95.

Kallet RH. A comprehensive review of prone position in ARDS. Respir Care. 2015. 60(11): p. 1660-1687.

Pelosi P, Brazzi L, Gattinoni L. Prone position in acute respiratory distress syndrome. Eur Respir. J. 2002; 20(4): p. 1017-1028.

Guerin C, Gaillard S, Lemasson S, Ayzac L, Girard R, Beuret P, et al.Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA. 2004; 292(19): p. 2379-2387.

Guerin C, Beuret P, Constantin JM, Bellani G, Garcia-Olivares P, Roca O, et al. A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study. Intensive Care Med. 2018; 44(1): p. 22-37.

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. 2020; 24(1): p. 28.

Munshi L, Sorbo LD, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO, et al. Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Ann AM thorac Soc. 2017; 14 (4): p. 280-288.

Marini JJ, Josephs SA, Mechlin M, Hurford WE. Should Early Prone Positioning Be a Standard of Care in ARDS With Refractory Hypoxemia? Resp Care. 2016; 61(11): p. 818-829.

Scholten EL, Beitler JR, Prisk GK, Malhotra A. Treatment of ARDS with prone positioning. Chest. 2017; 151(1): p. 215-224.

Pan C, Chen L, Cong L, Zhang W, Xia J, Sklar MC, et al. Lung recruitability in COVID-19–associated acute respiratory distress syndrome: a single-center observational study. Am J Respir Crit Care Med. 2020; 201(10): p. 1294-1297.

Sun Q, Qiu H, Huang M, Yang Y. Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu Province. Ann Intensive Care. 2020; 10(1): p. 1-4.

Elharrar X, Trigui Y, Dols A, Touchan F, Martinez S, Prud’homme E, et al. Use of prone positioning in nonintubated patients with COVID-19 and hypoxemic acute respiratory failure. JAMA. 2020; 323(22): p. 2336-2338.

Xu Z, Wang T, Qin X, Yanli J, Zha L, Lu W. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020; 8(4): p. 420-422.

Bamford P, Bentley A, Dean J, Whitmore D, Wilson-Baig N. ICS guidance for prone positioning of the conscious COVID patient 2020. 2020. Available from: https://emcrit.org/wp-content/uploads/2020/04/2020-04-12-Guidance-for-conscious-proning.pdf

Huan CF, Zhaung YF, Liu J, Tay CK, Sewa DW. Rationale and significance of patient selection in awake prone positioning for COVID-19 pneumonia. Eur Resp J. 2020. 56(3).

Damarla M, Zaeh S, Niedermayer S, Merck S, Nirajan-Azadi S, Broderick B, et al. Prone positioning of nonintubated patients with COVID-19. Am J Resp Critic Care Med. 2020; 202(4): p. 604-606.

Reddy MP, Subramanian A, Afroz A, Billah B, Lim ZJ, Zubarev A, et al. Prone positioning of non-intubated patients with COVID-19-A Systematic Review and Meta-analysis. Crit Care Med. 2020; 49(10): p. 1001-1014.

Ibarra-Estrada MA, Marín-Rosales M, García-Salcido R, Aguirre-Díaz SA, Vargas-Obieta A, Chávez-Peña Q, et al. Prone positioning in non-intubated patients with COVID-19 associated acute respiratory failure, the PRO-CARF trial: A structured summary of a study protocol for a randomised controlled trial. Trials. 2020; 21(1): p. 1-2.

Hepokoski ML, Odish M, Malhotra A. Prone positioning in acute respiratory distress syndrome: why aren’t we using it more? J Thorac Dis. 2018; 10 (9): p. S1020.

Pérez-Nieto OR, Guerrero-Gutiérez MA, Deloya-Tomas E, Namendys-Silva SA. Prone positioning combined with high-flow nasal cannula in severe noninfectious ARDS. Crit Care. 2020; 24(1): p. 1-3.

Malinowski AK, Snelgrove J, Okun N. Excluding pregnancy from COVID-19 trials: Protection from harm or the harm of protection? CMAJ. 2020; 192(23): p. E634-E634.

Bloomfield R, Noble DW, Sudlow AJC. Prone position for acute respiratory failure in adults. Cochrane. 2015; (11).

Griffiths MJ, McAuley DF, Perkins GD, Barret N, Blackwood B, Boyle A, et al. Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respir Res. 2019; 6(1): p. e000420.

Coppo A, Bellani G, Winterton D, Pierro MD, Faverio AP, Kairo M, 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. The Lancet. 2020; 8(8): p. 765-774.

Tan W, Xu DY, Xu MJ, Wang ZF, Dai B, Li LL et al. The efficacy and tolerance of prone positioning in non-intubation patients with acute hypoxemic respiratory failure and ARDS: a meta-analysis. SAGE. 2021; 15: p. 17534666211009407.

Qadri SK, Ng P, Toh TSW, Loh SW, Lin HCB, Fan E, et al. Critically Ill Patients with COVID-19: A Narrative Review on Prone Position. Pulm Ther. 2020; (6): p. 233–246.

Sartini C, Tresoldi M, Scarpellini P, Tettamanti A, Landoni FG, Zangrillo A. Respiratory Parameters in Patients With COVID-19 After Using Noninvasive Ventilation in the Prone Position Outside the Intensive Care Unit. JAMA. 2020; 323(22): p. 2338–2340.

Caputo ND, Strayer RJ, 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(5): p. 375-378.

Thompson AE, Ranard L, Wei Y, Jelic S. Prone Positioning in Awake, Nonintubated Patients With COVID-19 Hypoxemic Respiratory Failure. JAMA. 2020; 180 (11): p. 1539.




DOI: https://doi.org/10.34119/bjhrv5n3-202

Refbacks

  • There are currently no refbacks.