Awake prone positioning for non-intubated oxygen dependent COVID-19 pneumonia patients

摘要

Oxygenation failure recalcitrant to increasing positive end-expiratory pressure is a feature of severe coronavirus disease 2019 (COVID-19) pneumonia [1]. A Chinese group used prone positioning to improve oxygenation for intubated patients with severe COVID-19 pneumonia [2]. However, prone positioning in unconscious patients is labour-intensive and is associated with various complications [3, 4]. As the incidence of severe COVID-19 pneumonia worldwide increases rapidly, many countries are also facing the problem of diminishing intensive care resources. Prone positioning ventilation is most used today in intensive care units (ICU) for patients with acute respiratory distress syndrome (ARDS) [5–7] and for prevention of ventilator-induced lung injury [8, 9]. Many mechanisms have been proposed, including relieving the dependent lung regions from the compressive force of the heart’s weight [10] or increasing aeration in the originally dorsal lung regions [11]. The overall lung ventilation from dorsal to ventral areas is more homogeneous in the prone position than in the supine position. Prone positioning thus improves oxygenation whilst the other variable, perfusion, remains almost constant in both postures.