Hogeschool van Amsterdam

Urban Vitality

Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers

Article

Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6–12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.

Reference Stilma, W., Åkerman, E., Artigas, A., Bentley, A., Bos, L. D., Bosman, T. J. C., de Bruin, H., Brummaier, T., Buiteman-Kruizinga, L. A., Carcò, F., Chesney, G., Chu, C., Dark, P., Dondorp, A. M., Gijsbers, H. J. H., Gilder, M. E., Grieco, D. L., Inglis, R., Laffey, J. G., ... van der Woude, M. C. E. (2021). Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers. American Journal of Tropical Medicine and Hygiene , 104(5), 1676-1686. https://doi.org/10.4269/ajtmh.20-1445
Published by  Urban Vitality 1 January 2021

Publication date

Jan 2021

Author(s)

Eva Åkerman
Antonio Artigas
Andrew Bentley
Lieuwe D. Bos
Thomas J. C. Bosman
Hendrik de Bruin
Tobias Brummaier
Laura A. Buiteman-Kruizinga
Francesco Carcò
Gregg Chesney
Cindy Chu
Paul Dark
Arjen M. Dondorp
Harm J. H. Gijsbers
Mary Ellen Gilder
Domenico L. Grieco
Rebecca Inglis
John G. Laffey
Giovanni Landoni
Weihua Lu
Lisa M. N. Maduro
Rose McGready
Bairbre McNicholas
Diego de Mendoza
Luis Morales-Quinteros
Francois Nosten
Alfred Papali
Gianluca Paternoster
Luigi Pisani
Eloi Prud'homme
Jean-Damien Ricard
Oriol Roca
Chiara Sartini
Vittorio Scaravilli
Marcus J. Schultz
Chaisith Sivakorn
Peter E. Spronk
Jaques Sztajnbok
Youssef Trigui
Kathleen M. Vollman
Margaretha C. E. van der Woude

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