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