Non intubated prone positioning in intensive care, feasibility and indications

Authors

  • Stephan Ehrmann Médecine Intensive Réanimation, CHRU de Tours, INSERM CIC1415, CRICS-TriggerSEP F-CRIN research network et Centre d’Etude des Pathologies Respiratoires (CEPR), INSERM U1100, Université de Tours, Tours, France
  • Yonatan Perez Service de Médecine Intensive-Réanimation, Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
  • Augustin Pasquet Médecine Intensive Réanimation, CHRU de Tours, INSERM CIC1415, CRICS-TriggerSEP F-CRIN research network, Tours, France
  • Mathieu Thepenier Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Hôpital Nord et Aix-Marseille Université, Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Marseille, France.
  • Christophe Guervilly Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Hôpital Nord et Aix-Marseille Université, Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Marseille, France.

DOI:

https://doi.org/10.37051/mir-00129

Keywords:

Prone position, Awake prone position, Acute respiratory distress syndrome, Acute respiratory failure, COVID-19

Abstract

Prone positioning of non-intubated patients has been exceptionally popular during the COVID-19 pandemic. In this update, after covering the physiopathological rationale underlying this practice, the indications, contraindications as well as the feasibility are discussed. The scientific data from many observational studies but also from randomized trials are reviewed before considering the practical aspects of placing non-intubated intensive care patients in the prone position. Strong data suggest a benefit in terms of reducing the need for intubation in patients with hypoxemic acute respiratory failure related to COVID-19 with a good feasibility of the technique and few side effects. The indications are broad in these patients and it is advisable to target a daily duration of prone positioning of at least eight hours. Beyond that, additional work is needed to assess the potential benefits  of the technique in other patients groups.

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Published

2022-12-23

How to Cite

Ehrmann, S., Perez, Y., Pasquet, A., Thepenier, M., & Guervilly, C. (2022). Non intubated prone positioning in intensive care, feasibility and indications. Médecine Intensive Réanimation, 31(4), 273–290. https://doi.org/10.37051/mir-00129

Issue

Vol. 31 No. 4 (2022): Octobre-Décembre

Section

Update

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