The use of the pronation technique in mechanical ventilation

Authors

DOI:

https://doi.org/10.33448/rsd-v11i3.26040

Keywords:

Patients; Prone position; Respiration artificial.

Abstract

The use of prone mechanical ventilation has recently been incorporated into clinical practice, after studies have shown that the loss of lung volume in supine patients with acute respiratory distress syndrome is directly related to severity. This study aimed to analyze the use of the pronation technique in patients undergoing mechanical ventilation. The study is a bibliographic research of the integrative literature review type. The search for studies was performed using the PICO strategy, which represents an acronym for Patients (P), Intervention (I), Comparison (C) and Outcomes (O-outcomes). Data collection took place in August 2021 in the databases of the National Library of Medicine and the Virtual Health Library (VHL). 14 articles were included in this review. As for the results, it was shown that the main benefits of pronation are: improving oxygenation and minimizing harmful ventilation; avoid the use and complications of neuromuscular blockade; improve arterial blood oxygen pressure and saturation level in patients, among others. Despite the presence of complications, such as pressure injuries, which were relatively common, pronation is associated with a reduction in mortality and its use is highly recommended, since complications are relatively minor compared to the benefits of this practice. However, in the protocol of this technique it is recommended that protection measures be adhered to. Therefore, it is up to the team to assess the best approach to treat and monitor clients who are using mechanical ventilation.

References

Baudin, F., Emeriaud, G., Essouri, S., Beck, J., Portefaix, A., Javouhey, E., & Guerin, C. (2019). Physiological Effect of Prone Position in Children with Severe Bronchiolitis: A Randomized Cross-Over Study (BRONCHIO-DV). The Journal of Pediatrics, 205, 112-119. https://doi.org/10.1016/j.jpeds.2018.09.066.

Bork, A.M.T. (2005). Enfermagem baseada em evidencias. Rio de Janeiro: Guanabara Koonga.

Cao, Z., Yang, Z., Liang, Z., Cen, Q., Zhang, Z., Liang, ... Wang, Y. (2020). Prone versus Supine Position Ventilation in Adult Patients with Acute Respiratory Distress Syndrome: A Meta-Analysis of Randomized Controlled Trials. Emergency Medicine International, 2020, 1-9. https://doi.org/10.1155/2020/4973878.

De Carvalho, C. R. R., Toufen Junior, C., & Franca, S. A. (2007). Ventilação mecânica: princípios, análise gráfica e modalidades ventilatórias. Jornal Brasileiro de Pneumologia, 33, 54-70. https://doi.org/10.1590/S1806-37132007000800002.

Dornelles, C., De Oliveira, G. B., Schwonke, C. R. G. B., & Silva, J. R. S. (2012). Experiências de doentes críticos com a ventilação mecânica invasiva. Escola Anna Nery, 16(4), 796-801. https://doi.org/10.1590/s1414-81452012000400022.

Douglas, I. S., Rosenthal, C. A., Swanson, D. D., Hiller, T., Oakes, J., Bach, J., ... Neumeier, A. (2021). Safety and Outcomes of Prolonged Usual Care Prone Position Mechanical Ventilation to Treat Acute Coronavirus Disease 2019 Hypoxemic Respiratory Failure. Critical Care Medicine, 49(3), 490-502. https://doi.org/10.1097/CCM.0000000000004818.

Guérin, C., Beuret, P., Constantin, J. M., Bellani, G., Garcia-Olivares, P., Roca, O., ... Chrétien, J. M. (2017). A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study. Intensive Care Medicine, 44(1), 22-37. https://doi.org/10.1007/s00134-017-4996-5.

Hu, S., He, H., Pan, C., Liu, A., Liu, S., Liu, L., ... Qiu, H. (2014). The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. Critical Care, 18(3), R109. https://doi.org/10.1186/cc13896.

Jahani, S., Hajivand Soleymani, Z., Asadizaker, M., Soltani, F., & Cheraghian, B. (2018). Determination of the Effects of Prone Position on Oxygenation in Patients with Acute Respiratory Failure Under Mechanical Ventilation in ICU. Journal of Medicine and Life, 11(4), 274-280. https://doi.org/10.25122/jml-2018-0028.

Jochmans, S., Mazerand, S., Chelly, J., Pourcine, F., Sy, O., Thieulot-Rolin, N., ... Monchi, M. (2020). Duration of prone position sessions: a prospective cohort study. Annals of Intensive Care, 10(1): 1-9. https://doi.org/10.1186/s13613-020-00683-7.

Koulouras, V., Papathanakos, G., Papathanasiou, A., & Nakos, G. (2016). Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. World Journal of Critical Care Medicine, 5(2), 121-136. https://doi.org/10.5492/wjccm.v5.i2.121.

Langer, T., Brioni, M., Guzzardella, A., Carlesso, E., Cabrini, L., Castelli, G., ... Tonetti, T. (2021). Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients. Critical Care, 25(1), e128. https://doi.org/10.1186/s13054-021-03552-2.

Lee, H. Y., Cho, J., Kwak, N., Choi, S. M., Lee, J., Park, Y. S., ... Lee, S.-M. (2020b). Improved Oxygenation After Prone Positioning May Be a Predictor of Survival in Patients With Acute Respiratory Distress Syndrome*. Critical Care Medicine, 48(12), 1729-1736. https://doi.org/10.1097/ccm.0000000000004611.

Lee, S. J., Lee, Y., Kong, A., & Ng, S. Y. (2020a). Airway Pressure Release Ventilation Combined With Prone Positioning in Acute Respiratory Distress Syndrome. A & a Practice, 14(8), e01231. https://doi.org/10.1213/xaa.0000000000001231.

Lucchini, A., Bambi, S., Mattiussi, E., Elli, S., Villa, L., Bondi, H., ... Foti, G. (2020). Prone Position in Acute Respiratory Distress Syndrome Patients. Dimensions of Critical Care Nursing, 39(1), 39-46. https://doi.org/10.1097/dcc.0000000000000393.

Mathews, K. S., Soh, H., Shaefi, S., Wang, W., Bose, S., Coca, S., ... Leaf, D. E. (2021). Prone Positioning and Survival in Mechanically Ventilated Patients With Coronavirus Disease 2019–Related Respiratory Failure. Critical Care Medicine, 49, 1026-1037. https://doi.org/10.1097/ccm.0000000000004938.

Medina, M. G., Giovanella, L., Bousquat, A., Mendonça, M. H. M. de, & Aquino, R. (2020). Atenção primária à saúde em tempos de COVID-19: o que fazer? Cadernos de Saúde Pública, 36(8): 00149720. https://doi.org/10.1590/0102-311x00149720.

Munshi, L., Del Sorbo, L., Adhikari, N. K. J., Hodgson, C. L., Wunsch, H., Meade, M. O., … Fan, E. (2017). Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis. Annals of the American Thoracic Society, 14(Supplement_4), 280-288. https://doi.org/10.1513/annalsats.201704-343ot.

Nasser, S. M. T., & Narayanan, M. (2020). Does proning on NIV improve oxygenation? BMJ Case Reports, 13(10), e235243. https://doi.org/10.1136/bcr-2020-235243.

Oliveira, F. B. M., Costa, A. C. A. L., Alves, D. L., De França, J. F., De Macedo, M. S., Dos Santos, R. D. (2017). Relação entre a sobrecarga de trabalho e erros de administração de medicação na assistência hospitalar. Revista Ciência & Saberes, 2(4), 325-334.

Sahoo, J., Gurjar, M., Mohanty, K., Majhi, K., & Sradhanjali, G. (2019). Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series. International Journal of Critical Illness and Injury Science, 9(4), 182. https://doi.org/10.4103/ijciis.ijciis_62_18.

Shelhamer, M. C., Wesson, P. D., Solari, I. L., Jensen, D. L., Steele, W. A., Dimitrov, V. G., … Baxi, S. M. (2021). Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome Due to COVID-19: A Cohort Study and Analysis of Physiology. Journal of Intensive Care Medicine, 36(2), 241-252. https://doi.org/10.1177/0885066620980399.

Published

18/02/2022

How to Cite

SOUZA FILHO, C. A. P. .; OLIVEIRA , F. B. M. .; SILVA, W. C. da .; SOARES , B. S. .; SIQUEIRA, H. D. S. .; SIQUEIRA , F. F. F. S. .; SILVA , M. L. da .; CUNHA, H. G. S. S. .; SANTOS, R. R. L. dos; VITORIO, M. A. S. .; DUARTE, A. P. C. .; MIRANDA, L. S. C. .; MORAES , K. R. P. .; FERREIRA, E. H. B. .; GUIMARÃES , L. S. .; LIMA, J. H. A. de .; SILVA, R. A. da .; NEVES, S. R. das . The use of the pronation technique in mechanical ventilation. Research, Society and Development, [S. l.], v. 11, n. 3, p. e19711326040, 2022. DOI: 10.33448/rsd-v11i3.26040. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/26040. Acesso em: 19 jul. 2024.

Issue

Section

Review Article