PRONACIÓN CONSCIENTE EN PACIENTES CON COVID-19 SIN SOPORTE VENTILATORIO INVASIVO

Contenido principal del artículo

Freiser Eceomo Cruz Mosquera
Laura Nathaly Molina Galíndez
Jineth Tatiana España Pérez
Karol Vanessa Cortez Grisales
Claudia-Lorena Perlaza
Anisbed Naranjo Rojas

Resumen

Introducción: Durante la pandemia de la enfermedad por coronavirus (COVID-19), una de las intervenciones que ha adquirido importancia en el ámbito de las urgencias y hospitalización es la pronación consciente o auto-pronación. Esta técnica se destaca por su potencial para mejorar la oxigenación, reducir la necesidad de ventilación mecánica y disminuir la mortalidad asociada a la insuficiencia respiratoria hipoxémica. Objetivo: Describir los efectos de la auto-pronación consciente en pacientes con COVID-19, basándose en la evidencia científica existente. Métodos: Se llevó a cabo una revisión documental que incluyó la consulta de artículos publicados entre 2020 y 2023, que evaluaron los efectos del posicionamiento prono en pacientes conscientes con diagnóstico de COVID-19. La búsqueda se realizó en diversas bases de datos, como PubMed, Science Direct, Scopus, LILACS, Web of Science y el Registro Central Cochrane de Ensayos Clínicos Controlados, durante el período comprendido entre enero y abril de 2023. Resultados: Se incluyeron un total de 12 ensayos clínicos y un meta-ensayo en el análisis. La mayoría de los estudios establecen que el posicionamiento prono en pacientes conscientes puede generar mejoras en variables fisiológicas como la saturación de oxígeno, PaO2 e índice Kirby. Sin embargo, su impacto en la tasa de intubación, estancia hospitalaria y mortalidad es controversial. Conclusión: A partir de la evidencia cientifica existente, la auto-pronación consciente en pacientes con COVID-19 se revela como una técnica valiosa en las salas de urgencias y hospitalización, debido a su efecto en las variables de oxigenación, sin embargo, su influencia en la estancia hospitalaria y la mortalidad aun es cuestionada.


 Palabras clave: COVID-19, SARS-Cov-2, posición prona, pronación.


ABSTRACT


Introduction: During the COVID-19 pandemic, one of the interventions that has gained importance in the field of emergencies and hospitalization is conscious pronation or self-pronation. This technique stands out for its potential to improve oxygenation, reduce the need for mechanical ventilation, and decrease mortality associated with hypoxemic respiratory failure. Objective: To describe the effects of conscious pronation in patients with COVID-19, based on existing scientific evidence. Methods: An documentary review was carried out that included the consultation of articles published between 2020 and 2023, which evaluated the effects of prone positioning in conscious patients diagnosed with COVID-19. The search was carried out in various databases, such as PubMed, Science Direct, Scopus, LILACS, Web of Science and the Cochrane Central Register of Controlled Clinical Trials, during the period between January and April 2023. Results: A total of of 12 clinical trials and one meta-trial in the analysis. Most studies establish that prone positioning in conscious patients can lead to improvements in physiological variables such as oxygen saturation, PaO2, and Kirby index. However, its impact on the intubation rate, hospital stay, and mortality is controversial. Conclusion: Self-pronation is revealed as a valuable technique in emergency rooms and hospitalization due to its effect on oxygenation variables, however, its influence on hospital stay and mortality is still questioned



Keywords: COVID-19, SARS-Cov-2, prone position, conscious prone position

Descargas

Los datos de descargas todavía no están disponibles.

Detalles del artículo

Cómo citar
Cruz Mosquera, F. E. ., Molina Galíndez, L. N. ., España Pérez, J. T. ., Cortez Grisales, K. V. ., Perlaza, C.-L. ., & Naranjo Rojas, A. . (2023). PRONACIÓN CONSCIENTE EN PACIENTES CON COVID-19 SIN SOPORTE VENTILATORIO INVASIVO. Enfermería Investiga, 8(3), 86–92. https://doi.org/10.31243/ei.uta.v8i3.2205.2023
Sección
Articulo de revisión

Citas

Shi Y, Wang G, Cai X peng, Deng J wen, Zheng L, Zhu H hong, et al. An overview of COVID-19. J Zhejiang Univ Sci B.2020;21(5):343-60. DOI: 10.1631/jzus.B2000083.

Ena J, Wenzel RP. Un nuevo coronavirus emerge. Revista Clínica Española. marzo de 2020;220(2):115-6. DOI:10.1016/j.rce.2020.01.001

División de Protección Social y Salud del BID. Situación actual de la pandemia/IADB [Internet]. Banco interamericano de desarrollo; 2023. Disponible en: https://www.iadb.org/es/coronavirus/situacion-actual-de-la-pandemia

Instituto Nacional de Salud. COVID-19 en Colombia [Internet]. Instituto Nacional de Salud; 2023. Disponible en: https://www.ins.gov.co/Noticias/paginas/coronavirus.aspx

Pinzón J. Curva epidémica para COVID-19 en Colombia para los años 2020-2021. Revista Repertorio de Medicina y Cirugía. 2022; 31: 10-13. DOI: https://doi.org/10.31260/RepertMedCir.01217372.1326

Gil R, Bitar P, Deza C, Dreyse J, Florenzano M, Ibarra C, et al. Cuadro clínico del COVID-19. Revista Médica Clínica Las Condes. enero de 2021;32(1):20-9. DOI: 10.1016/j.rmclc.2020.11.004

Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239. DOI:10.1001/jama.2020.2648

Li T. Diagnosis and clinical management of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection: an operational recommendation of Peking Union Medical College Hospital (V2. Emerging Microbes & Infections. 2020;9(1):582-5. DOI: 10.1080/22221751.2020.1735265

Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. The Lancet Respiratory Medicine.2020;8(8):765-74. DOI: 10.1016/S2213-2600(20)30268-X.

Zylberman M, Ruiz C, Estevan C, Odzak A, Arcondo F, Fornasari L, et al. Pronación consciente como parte del tratamiento de la neumonía por COVID-19. ASEI. 2021;29(105): 27-33. DOI: https://doi.org/10.52226/revista.v29i105.51

Jiang LG, LeBaron J, Bodnar D, Caputo ND, Chang BP, Chiricolo G, et al. Conscious Proning: An Introduction of a Proning Protocol for Nonintubated, Awake, Hypoxic Emergency Department COVID‐19 Patients. Acad Emerg Med. julio de 2020;27(7):566-9. doi: 10.1111/acem.14035.

Hernández E, Cadena F, Zarazúa J, Reyes K, García Pineda M, Villarreal J. Efectos del decúbito prono en el tratamiento de síndrome respiratorio agudo en pacientes con COVID-19.2021; 30(3):184-188.

Yarahmadi S, Ebrahimzadeh F, Mohamadipour F, Cheraghian T, Eskini M. Effect of Prone Position on Clinical Outcomes of Non-Intubated Patients with Covid-19: A Randomized Clinical Trial. Collegian. 2023; 30(3):449-456. DOI: 10.1016/j.colegn.2022.12.005

Institute TJB. Methodology for JBI Scoping Reviews. Reviewers’ Manual. [Internet]. Australia. The Joanna Briggs Institute; 2015. Disponible en: https://www.researchgate.net/publication/294736492_Methodology_for_JBI_Scoping_Reviews

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. febrero de 2005;8(1):19-32. DOI: https://doi.org/10.1080/1364557032000119616

Page MJ, Moher D. Evaluations of the uptake and impact of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement and extensions: a scoping review. Syst Rev.2017;6(1):263. DOI: 10.1186/s13643-017-0663-8.

Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro Scale for Rating Quality of Randomized Controlled Trials. Physical Therapy. 2003;83(8):713-21. Disponible: https://pubmed.ncbi.nlm.nih.gov/12882612/

Gopalakrishnan M, Khichar S, Saurabh S, Vijayvergia P, Thangaraju K, Tripathi S, et al. Effectiveness of early awake self proning strategy in non-intubated patients with COVID-19 hypoxemia: An open-labelled randomized clinical trial from Jodhpur, India. Monaldi Arch Chest Dis. 2022. DOI: 10.4081/monaldi.2022.2431.

Othman SY, El‐Menshawy AM, Mohamed AM. Effects of awake‐prone positioning on oxygenation and physiological outcomes in non‐intubated patients with COVID ‐19: A randomized controlled trial. Nursing in Critical Care.2022; nicc.12833. : 1DOI0.1111/nicc.12833.

Yarahmadi S, Ebrahimzadeh F, Mohamadipour F, Cheraghian T, Eskini M. Effect of Prone Position on Clinical Outcomes of Non-Intubated Patients with Covid-19: A Randomized Clinical Trial. Collegian. 2022;30(3):449-456. DOI: 10.1016/j.colegn.2022.12.005.

Lehingue S, Allardet-Servent J, Ferdani A, Hraelch S, Forel JM, Arnal JM, et al. Physiologic Effects of the Awake Prone Position Combined With High-Flow Nasal Oxygen on Gas Exchange and Work of Breathing in Patients With Severe COVID-19 Pneumonia: A Randomized Crossover Trial. Critical Care Explorations. 2022;4(12):e0805. DOI: 10.1097/CCE.0000000000000805.

Alhazzani W, Parhar KKS, Weatherald J, Al Duhailib Z, Alshahrani M, Al-Fares A, et al. Effect of Awake Prone Positioning on Endotracheal Intubation in Patients With COVID-19 and Acute Respiratory Failure: A Randomized Clinical Trial. JAMA. 2022;327(21):2104-13. DOI: 10.1001/jama.2022.7993.

Ibarra-Estrada M, Li J, Pavlov I, Perez Y, Roca O, Tavernier E, et al. Factors for success of awake prone positioning in patients with COVID-19-induced acute hypoxemic respiratory failure: analysis of a randomized controlled trial. Crit Care. 2022;26(1):84. DOI: 10.1186/s13054-022-03950-0.

Qian ET, Gatto CL, Amusina O, Dear ML, Hiser W, Buie R, et al. Assessment of Awake Prone Positioning in Hospitalized Adults With COVID-19: A Nonrandomized Controlled Trial. JAMA Intern Med. 1 de junio de 2022;182(6):612-621. DOI: 10.1001/jamainternmed.2022.1070.

Fralick M, Colacci M, Munshi L, Venus K, Fidler L, Hussein H, et al. Prone positioning of patients with moderate hypoxaemia due to covid-19: multicentre pragmatic randomised trial (COVID-PRONE). BMJ. 2022;e068585. DOI: 10.1136/bmj-2021-068585.

Kharat A, Dupuis-Lozeron E, Cantero C, Marti C, Grosgurin O, Lolachi S, et al. Self-proning in COVID-19 patients on low-flow oxygen therapy: a cluster randomised controlled trial. ERJ Open Res. 2021;7(1):00692-2020. DOI: 10.1183/23120541.00692-2020.

Kaur R, Vines DL, Mirza S, Elshafei A, Jackson JA, Harnois LJ, et al. Early versus late awake prone positioning in non-intubated patients with COVID-19. Crit Care. diciembre de 2021;25(1):340. DOI: 10.1186/s13054-021-03761-9.

Johnson SA, Horton DJ, Fuller MJ, Yee J, Aliyev N, Boltax JP, et al. Patient-directed Prone Positioning in Awake Patients with COVID-19 Requiring Hospitalization (PAPR). Annals ATS. 2021;18(8):1424-26. DOI: 10.1513/AnnalsATS.202011-1466RL.

Rosén J, von Oelreich E, Fors D, Jonsson Fagerlund M, Taxbro K, Skorup P, et al. Awake prone positioning in patients with hypoxemic respiratory failure due to COVID-19: the PROFLO multicenter randomized clinical trial. Crit Care. 2021;25(1):209. DOI: 10.1186/s13054-021-03602-9.

Ehrmann S, Li J, Ibarra-Estrada M, Perez Y, Pavlov I, McNicholas B et al. Awake Prone Positioning Meta-Trial Group. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med. 2021;9(12):1387-1395. DOI: 10.1016/S2213-2600(21)00356-8.

Cruz F, Naranjo A, Moreno S. Cánula nasal de alto flujo en pacientes con COVID-19: evidencia 120 días después del inicio de la pandemia. An. Fac. med. 2020; 81(3): 365-367. DOI: http://dx.doi.org/10.15381/anales.v81i3.18383.