The use of the prone position in spontaneous ventilation in a patient with COVID-19

A case report

Abstract

OBJECTIVE: Describes a case of an adult COVID-19, who was addmited patient admitted to an intensive care unit (ICU) and submitted to the prone position.

CASE REPORT: Female patient, 44 years old, with a previous metabolic syndrome and acquired immuno-deficiency syndrome, arrived at the emergency department. She had fever, nasal congestion, but without dyspnea. After clinical and imaging tests, she was transferred to an ICU, with suspected COVID-19. Upon arrival at the intensive unit, she was breathing spontaneously with low flow oxygen therapy, presenting hypoxemia. In addition to the established medical therapies, he was instructed to position himself in the PP for a period of 15 to 30 minutes, performed once when turning. Arterial blood gases increase to 96mmHg in PaO2 and consequently 18% in the PaO2 / FiO2 ratio, in addition to the favorable clinical evolution.

CONCLUSIONS: The early indication of PP as an additional therapy in the treatment of COVID-19 patients, can have contributed to the favorable clinical outcome, especially with regard to oxygenation, evidenced by the improvement of PaO2 parameters, PaO2/FiO2 ratio and progress discharged.

Downloads

Download data is not yet available.

Author Biographies

Thiele Cabral Coelho Quadros, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas da PUCRS, Porto Alegre, RS, Brasil.

Mestre em Ciências Cardiovasculares – Cardiologia pela Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil; Fisioterapeuta do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Thaline Lima Horn, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas da PUCRS, Porto Alegre, RS, Brasil.

Fisioterapeuta residente do Programa de Residência Multiprofissional em Saúde (PREMUS) – Ênfase Urgência e Emergência pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Alexandre Ribas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas da PUCRS, Porto Alegre, RS, Brasil.

Mestre em Ciências Pneumológicas pela Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil; Fisioterapeuta do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Bruna Possobon Soares, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas da PUCRS, Porto Alegre, RS, Brasil.

Bacharel em Fisioterapia pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil; Fisioterapeuta do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Denizar Alberto da Silva Melo , Pontifícia Universidade Católica do Rio Grande do Sul, Escola das Ciências da Vida, Porto Alegre, RS, Brasil.

Doutor em Ciências da Saúde pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil; Diretor de Graduação Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

References

Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565-74. https://doi.org/10.1016/s0140-6736(20)30251-8

Word Health Organization. Novel Coronavirus (2019- nCoV) - Situation Report 22 [Internet]. 2020 Feb 11 [cited

Jan 20]. Available from: https://apps.who.int/iris/bitstream/handle/10665/330991/nCoVsitrep11Feb-2020-eng.pdf?sequence=1&isAllowed=y

Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19). [Updated 2021 Jan 16]. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2021 Jan. Available fro: https://www.ncbi.nlm.nih.gov/books/NBK554776/

Phua J, Weng L, Ling L, Egi M, Lim C-M, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Resp Med. 2020;8(5):506-17. https://doi.org/10.1016/S2213-2600(20)30161-2

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). Crit Care Med. 2020;46:854-87. https://doi.org/10.1007/s00134-020-06022-5

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):1574-81. http://jamanetwork.com/article.aspx?doi=10.1001/jama.2020.5394

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. Lancet Respir Med. 2020;8(5):475-81. https://doi.org/10.1016/S2213-2600(20)30079-5

Bhatraju PK, Ghassemieh 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):2012-22. https;//www.nejm.org/doi/full/10.1056/nejmoa2004500

Kallet RH. A Comprehensive review of prone position in ARDS. Respir Care. 2015;60(11):1660-87. https://doi.org/10.4187/respcare.04271

Oliveira VM, Piekala DM, Deponti GN, Batista DCR, Minossi SD, Chisté M, et al. Checklist da prona segura: construção e implementação de uma ferramenta para realização da manobra de prona. Rev Bras Ter Intensiva. 2017;29(2):131-41. https://doi.org/10.5935/0103-507x.20170023

Valter C, Christensen AM, Tollund C, Schonemann NK. Response to the prone position in spontaneously breathing patients with hypoxemic respiratory failure. Acta Anaesthesiol Scand. 2003;47(4):416-8. https://doi.org/10.1034/j.1399-6576.2003.00088.x

Seguras Llanes O, Yora Orta R, Gutiérrez Gutiérrez L, García Gómez AJRCdAyR. Ventilación prona en pacientes con daño pulmonar agudo ingresados en cuidados intensivos. 2011;10(1):43-51. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1726-67182011000100006

Guerin 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):2159-68. https://doi.org/10.1056/nejmoa2004500

Scaravilli V, Grasselli G, Castagna L, Zanella A, Isgrò S, Lucchini A, et al. Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: a retrospective study. J Crit Care. 2015;30(6):1390-4. https://doi.org/10.1016/j.jcrc.2015.07.008

Bamford P, Bentley A, Dean J, Whitmore D, Wilson- Baig N. ICS Guidance for prone positioning of the conscious COVID patient 2020 [Internet]. Guidelines. Intensive Care Society; 2020 [Cited 2021 01 20]. Available from: https://emcrit.org/wp-content/uploads/2020/04/2020-04-12-Guidance-for-conscious-proning.pdf

Gattinoni L, Vagginelli F, Carlesso E, Taccone P, Conte V, Chiumello D, et al. Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Crit Care Med. 2003;31(12):2727-33. https://doi.org/10.1097/01.ccm.0000098032.34052.f9

Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D. Covid-19 does not lead to a “typical” acute respiratory distress syndrome. Am J Resp Crit Care Med. 2020;201(10):1299-1300. https://doi.org/10.1164/rccm.202003-0817LE

Rajagopal K, Keller SP, Akkanti B, Bime C, Loyalka P, Cheema FH, et al. Advanced pulmonary and cardiac support of COVID-19 patients: emerging recommendations from ASAIO- a living working document. Circ Heart Fail. 2020;13(5):e007175. https://doi.org/10.1161/CIRCHEARTFAILURE.120.007175

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):28. https://doi.org/10.1186/s13054-020-2738-5

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):375-8. https://doi.org/10.1111/acem.13994

Slessarev M, Cheng J, Ondrejicka M, Arntfield R, Group CCWR. Patient self-proning with high-flow nasal cannula improves oxygenation in COVID-19 pneumonia. Can J Anaesth. 2020;67(9):1288-90. https://doi.org/10.1007/s12630-020-01661-0

Elkattawy S, Noori M. A case of improved oxygenation in SARS-CoV-2 positive patient on nasal cannula undergoing prone positioning. Respir Med Case Rep. 2020;30:101070. https://doi.org/10.1016/j.rmcr.2020.101070

Elharrar X, Trigui Y, Dols A-M, Touchon 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):2236-8. https://doi.org/10.1001/jama.2020.8255

Published
2021-03-11
How to Cite
Cabral Coelho Quadros, T. ., Lima Horn, T. ., Ribas, A. ., Blattner, C. N., Possobon Soares, B. ., & da Silva Melo , D. A. (2021). The use of the prone position in spontaneous ventilation in a patient with COVID-19: A case report. Scientia Medica, 31(1), e39982. https://doi.org/10.15448/1980-6108.2021.1.39982