Posição prona em pacientes com insuficiência respiratória secundária à COVID-19
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Oct 21, 2023
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Resumo
Objetivo: Verificar quais são os efeitos da posição prona em pacientes com Síndrome do Desconforto Respiratório Agudo (SDRA) causada pela COVID-19, investigando dados epidemiológicos, clínicos e laboratoriais. Métodos: Trata-se de um estudo longitudinal e retrospectivo, realizado em um hospital filantrópico da região noroeste do estado do Espírito Santo. Participaram do estudo 33 pacientes com diagnóstico de SDRA secundária à COVID-19, em ventilação mecânica invasiva, pronados duas vezes durante a internação na unidade de terapia intensiva adulto admitidos no período de junho de 2020 a fevereiro de 2022. Foi utilizado o teste de Shapiro Wilk e o teste de Mann-Whitney para comparar os dois grupos. Resultados: Houve redução do valor da PaO2 17,03 – 13,80; avaliada. Destaca-se também a redução da relação PaO2/FIO2 49,05 – 30,77; (p=0,093), sem relevância estatística. Houve aumento no parâmetro ventilatório da PEEP -0,30 – 0,12; (p=0,434). Conclusão: Conclui-se que a posição prona influenciou na oferta de fração inspirada de oxigênio – FiO2, com valor estatisticamente significante, e não houve melhora relevante nas relações da PaO2/FiO2, SatO2 ou PaO2. Além disso, observou-se uma elevação nos valores de lactato.
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Como Citar
LimeiraJ. M., SchrioderR. P., GamaJ. de L., PereiraL. A., RedigheiriM. G., OliveiraG., MiguezF. G. G., SilvaB. S. da, Enriquez-MartinezO. G., & Quintela-CastroF. C. de A. (2023). Posição prona em pacientes com insuficiência respiratória secundária à COVID-19. Revista Eletrônica Acervo Saúde, 23(10), e14215. https://doi.org/10.25248/reas.e14215.2023
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Referências
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2. ALTINAY M, et al. Effect of early awake prone positioning application on prognosis in patients with acute respiratory failure due to COVID-19 pneumonia: a retrospective observational study. Sociedade Brasileira de Anestesiologia. 2022; 72 (2):1-6.
3. ANANIAS MANB, et al. Effect of prone position on respiratory mechanics and gas exchanges in patients with severe ARDS. Revista Médica de Minas Gerais. 2018; 28(5): e-S2805-28.
4. ARAÚJO MS, et al. Posição prona como ferramenta emergente na assistência ao paciente acometido por COVID-19: scoping review. Revista Latino-Americana de Enfermagem. 2021; 29: e3397.
5. AULIAWATI D, et al. SpO2/FiO2 Ratio as an Oxygenation Parameter in Pediatric Acute Respiratory Distress Syndrome. Bali Medical Journal. 2016; 5(2): 358–361.
6. CAMPOROTA L, et al. Identification of pathophysiological patterns for triage and respiratory support in COVID-19. Lancet Respiratory Medicine. 2020; 8(8): 752-754.
7. CAMPOROTA, MD, et al. Prone Position in COVID-19 and -COVID-19 Acute Respiratory Distress Syndrome: An International Multicenter Observational Comparative Study. Critical Care Medicine. 2022; 50(4): 633-643.
8. CAVALCANTI AB, et al. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients with Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2017; 318(14): 1335-1345.
9. CHUA EX, et al. Prone ventilation in intubated COVID-19 patients: a systematic review and meta-analysis. Brazilian Journal Anesthesiology. 2022; 72(6): 780-789.
10. COPPO A, 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 Respiratory Medicine. 2020; 8(8): 765-774.
11. COUR M, et al. Differential effects of prone position in COVID-19-related ARDS in low and high recruiters. Intensive Care Medicine. 2021; 47(9): 1044-1046.
12. CUNHA MCA, et al. Impact of prone positioning on patients with COVID-19 and ARDS on invasive mechanical ventilation: a multicenter cohort study. Jornal Brasileiro de Pneumologia. 2022; 48(2): e20210374.
13. DUARTE MP, et al. Correlation of paco2 before and at end of the prone position as a prediction of best outcomes in severe acute respiratory syndrome from Covid-19. Brazilian Journal of Development. 2022; 8(7): 51626-51636.
14. GATTINONI L, et al. Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Critical Care Medicine. 2003; 31(12): 2727-2733.
15. GATTINONI L, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. New England Journal of Medicine. 2001; 345: 568-573.
16. GATTINONI L, et al. The “baby lung” became an adult. Intensive care medicine. 2016; 42: 663-673.
17. GHELICHKHANI P e ESMAEILI M. Prone Position in Management of COVID-19 Patients; a Commentary. Archives of Academic Emergency Medicine. 2020; 8(1): e48.
18. GRASSELLI G, et al. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet Respiratory Medicine. 2020; 8(12): 1201-1208.
19. GUÉRIN, C, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Medicine. 2020; 46: 2385-2396.
20. HU SL, et al. The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. Critical Care. 2014; 18(3): R109.
21. KARPOV A, et al. Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure. Critical Care Research and Practice. 2020; 1–7.
22. KHULLAR R, et al. Effects of Prone Ventilation on Oxygenation, Inflammation, and Lung Infiltrates in COVID-19 Related Acute Respiratory Distress Syndrome: A Retrospective Cohort Study. Journal of Clinical Medicine. 2020; 9(12): 4129.
23. KOECKERLING D, et al. Awake prone positioning in COVID-19. Thorax. 2020; 75: 833-834.
24. KOULOURAS V, et al. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. World Journal of Critical Care Medicine. 2016; 5(2): 121-36.
25. LANGER T, et al. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients. Critical Care. 2021; 25: 128.
26. MUNSHI L, et. al. Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis. Annals of the American Thoracic Society. 2017; 14: S280–S288.
27. MUNSHI L, et. al. Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis. Annals of the American Thoracic Society. 2017; 14: S280–S288.
28. NI Z, et al. Efficacy of early prone or lateral positioning in patients with severe COVID-19: a single-center prospective cohort. Precision Clinical Medicine. 2020; 1-12.
29. PADRÃO EH, et al. Awake Prone Positioning in COVID-19 Hypoxemic Respiratory Failure: Exploratory Findings in a Single-center Retrospective Cohort Study. Academic Emergency Medicine. 2020, 1-11.
30. ROCCO IS, et al. Cardiovascular involvement in COVID-19: not to be missed. Brazilian Journal of Cardiovascular Surgery. 2020: 1-9.
31. RAHMANI F, et al. Prone Position Effects in the Treatment of COVID-19 Patients. Caspian Journal of Internal Medicine. 2020; 11(1): S580–S582.
32. ROCHA ARM, et al. Ventilação Mecânica na Insuficiência Respiratória Viral: COVID-19. In: VALIATTI JLS, et al. Ventilação Mecânica - Fundamentos e Prática Clínica. Rio de Janeiro: Grupo GEN. 2021; 2: 854p.
33. RONCO C, et al. Management of acute kidney injury in patients with COVID-19. Lancet Respiratory Medicine. 2020; 8(7): 738-742.
34. SARTINI C, et al. Respiratory Parameters in Patients With COVID-19 After Using Noninvasive Ventilation in the Prone Position Outside the Intensive Care Unit. JAMA. 2020; 323: 2338-2340.
35. TATLOW C, et al. Physiotherapy-assisted prone or modified prone positioning in ward-based patients with COVID-19: a retrospective cohort study. Physiotherapy. 2022; 114: 47-53.
36. TONELLI R. et al. Spontaneous Breathing and Evolving Phenotypes of Lung Damage in Patients with COVID-19: Review of Current Evidence and Forecast of a New Scenario. Journal of Clinical Medicine. 2021; 10: 975.
37. WEISS TT, et al. Prone positioning for patients intubated for severe acute respiratory distress syndrome (ARDS) secondary to COVID-19: a retrospective observational cohort study. Brazilian Journal Anesthesiology. 2021;126(1):48-55.
38. WRIGHT AD, et al. Using the prone position for ventilated patients with respiratory failure: a review. Nursing in Critical Care. 2011; 16(1): 19-27.
39. YE Q, et al. The pathogenesis and treatment of the ‘Cytokine Storm’ in COVID-19. Journal of Infection. 2020; 80(6): 607-613.
2. ALTINAY M, et al. Effect of early awake prone positioning application on prognosis in patients with acute respiratory failure due to COVID-19 pneumonia: a retrospective observational study. Sociedade Brasileira de Anestesiologia. 2022; 72 (2):1-6.
3. ANANIAS MANB, et al. Effect of prone position on respiratory mechanics and gas exchanges in patients with severe ARDS. Revista Médica de Minas Gerais. 2018; 28(5): e-S2805-28.
4. ARAÚJO MS, et al. Posição prona como ferramenta emergente na assistência ao paciente acometido por COVID-19: scoping review. Revista Latino-Americana de Enfermagem. 2021; 29: e3397.
5. AULIAWATI D, et al. SpO2/FiO2 Ratio as an Oxygenation Parameter in Pediatric Acute Respiratory Distress Syndrome. Bali Medical Journal. 2016; 5(2): 358–361.
6. CAMPOROTA L, et al. Identification of pathophysiological patterns for triage and respiratory support in COVID-19. Lancet Respiratory Medicine. 2020; 8(8): 752-754.
7. CAMPOROTA, MD, et al. Prone Position in COVID-19 and -COVID-19 Acute Respiratory Distress Syndrome: An International Multicenter Observational Comparative Study. Critical Care Medicine. 2022; 50(4): 633-643.
8. CAVALCANTI AB, et al. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients with Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2017; 318(14): 1335-1345.
9. CHUA EX, et al. Prone ventilation in intubated COVID-19 patients: a systematic review and meta-analysis. Brazilian Journal Anesthesiology. 2022; 72(6): 780-789.
10. COPPO A, 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 Respiratory Medicine. 2020; 8(8): 765-774.
11. COUR M, et al. Differential effects of prone position in COVID-19-related ARDS in low and high recruiters. Intensive Care Medicine. 2021; 47(9): 1044-1046.
12. CUNHA MCA, et al. Impact of prone positioning on patients with COVID-19 and ARDS on invasive mechanical ventilation: a multicenter cohort study. Jornal Brasileiro de Pneumologia. 2022; 48(2): e20210374.
13. DUARTE MP, et al. Correlation of paco2 before and at end of the prone position as a prediction of best outcomes in severe acute respiratory syndrome from Covid-19. Brazilian Journal of Development. 2022; 8(7): 51626-51636.
14. GATTINONI L, et al. Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Critical Care Medicine. 2003; 31(12): 2727-2733.
15. GATTINONI L, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. New England Journal of Medicine. 2001; 345: 568-573.
16. GATTINONI L, et al. The “baby lung” became an adult. Intensive care medicine. 2016; 42: 663-673.
17. GHELICHKHANI P e ESMAEILI M. Prone Position in Management of COVID-19 Patients; a Commentary. Archives of Academic Emergency Medicine. 2020; 8(1): e48.
18. GRASSELLI G, et al. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet Respiratory Medicine. 2020; 8(12): 1201-1208.
19. GUÉRIN, C, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Medicine. 2020; 46: 2385-2396.
20. HU SL, et al. The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. Critical Care. 2014; 18(3): R109.
21. KARPOV A, et al. Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure. Critical Care Research and Practice. 2020; 1–7.
22. KHULLAR R, et al. Effects of Prone Ventilation on Oxygenation, Inflammation, and Lung Infiltrates in COVID-19 Related Acute Respiratory Distress Syndrome: A Retrospective Cohort Study. Journal of Clinical Medicine. 2020; 9(12): 4129.
23. KOECKERLING D, et al. Awake prone positioning in COVID-19. Thorax. 2020; 75: 833-834.
24. KOULOURAS V, et al. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. World Journal of Critical Care Medicine. 2016; 5(2): 121-36.
25. LANGER T, et al. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients. Critical Care. 2021; 25: 128.
26. MUNSHI L, et. al. Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis. Annals of the American Thoracic Society. 2017; 14: S280–S288.
27. MUNSHI L, et. al. Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis. Annals of the American Thoracic Society. 2017; 14: S280–S288.
28. NI Z, et al. Efficacy of early prone or lateral positioning in patients with severe COVID-19: a single-center prospective cohort. Precision Clinical Medicine. 2020; 1-12.
29. PADRÃO EH, et al. Awake Prone Positioning in COVID-19 Hypoxemic Respiratory Failure: Exploratory Findings in a Single-center Retrospective Cohort Study. Academic Emergency Medicine. 2020, 1-11.
30. ROCCO IS, et al. Cardiovascular involvement in COVID-19: not to be missed. Brazilian Journal of Cardiovascular Surgery. 2020: 1-9.
31. RAHMANI F, et al. Prone Position Effects in the Treatment of COVID-19 Patients. Caspian Journal of Internal Medicine. 2020; 11(1): S580–S582.
32. ROCHA ARM, et al. Ventilação Mecânica na Insuficiência Respiratória Viral: COVID-19. In: VALIATTI JLS, et al. Ventilação Mecânica - Fundamentos e Prática Clínica. Rio de Janeiro: Grupo GEN. 2021; 2: 854p.
33. RONCO C, et al. Management of acute kidney injury in patients with COVID-19. Lancet Respiratory Medicine. 2020; 8(7): 738-742.
34. SARTINI C, et al. Respiratory Parameters in Patients With COVID-19 After Using Noninvasive Ventilation in the Prone Position Outside the Intensive Care Unit. JAMA. 2020; 323: 2338-2340.
35. TATLOW C, et al. Physiotherapy-assisted prone or modified prone positioning in ward-based patients with COVID-19: a retrospective cohort study. Physiotherapy. 2022; 114: 47-53.
36. TONELLI R. et al. Spontaneous Breathing and Evolving Phenotypes of Lung Damage in Patients with COVID-19: Review of Current Evidence and Forecast of a New Scenario. Journal of Clinical Medicine. 2021; 10: 975.
37. WEISS TT, et al. Prone positioning for patients intubated for severe acute respiratory distress syndrome (ARDS) secondary to COVID-19: a retrospective observational cohort study. Brazilian Journal Anesthesiology. 2021;126(1):48-55.
38. WRIGHT AD, et al. Using the prone position for ventilated patients with respiratory failure: a review. Nursing in Critical Care. 2011; 16(1): 19-27.
39. YE Q, et al. The pathogenesis and treatment of the ‘Cytokine Storm’ in COVID-19. Journal of Infection. 2020; 80(6): 607-613.