Prone positioning as an emerging tool in the care provided to patients infected with COVID-19: a scoping review

Araújo, Marília Souto de; Santos, Marina Marisa Palhano dos; Silva, Carlos Jordão de Assis; Menezes, Rejane Maria Paiva de; Feijão, Alexsandra Rodrigues; Medeiros, Soraya Maria de

doi:10.1590/1518-8345.4732.3397

Brasil

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Review Article • Rev. Latino-Am. Enfermagem 29 • 2021 • https://doi.org/10.1590/1518-8345.4732.3397 linkcopy

Prone positioning as an emerging tool in the care provided to patients infected with COVID-19: a scoping review^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to describe scientific evidence regarding the use of prone positioning in the care provided to patients with acute respiratory failure caused by COVID-19.

Method: this is a scoping review. PRISMA Extension for Scoping Reviews was used to support the writing of this study. The search was conducted in seven databases and resulted in 2,441 studies, 12 of which compose the sample. Descriptive statistics, such as relative and absolute frequencies, was used to analyze data.

Results: prone positioning was mainly adopted in Intensive Care Units, lasted from a minimum of 12 up to 16 hours, and its prescription was based on specific criteria, such as PaO₂/FiO₂ ratio, oxygen saturation, and respiratory rate. The most prevalent complications were: accidental extubation, pressure ulcer, and facial edema. Decreased hypoxemia and mortality rates were the main outcomes reported.

Conclusion: positive outcomes outweighed complications. Various cycles of prone positioning are needed, which may cause potential work overload for the health staff. Therefore, an appropriate number of trained workers is necessary, in addition to specific institutional protocols to ensure patient safety in this context.

Descriptors: Coronavirus Infections; Respiratory Tract Infections; Adult Respiratory Distress Syndrome; Prone Position; Nursing; Critical Care

ID^* * ID = Identification;	Country	Method	Objective	Main conclusions	LE^† † LE = Level of evidence;
A1⁽¹²⁾	USA	Case study	To verify the effect of prone positioning in one patient who tested positive for SARS-CoV-2.	PP is a vital part of the management plan and should be adopted early on to decrease mortality.	4d
A2⁽¹³⁾	China	Expert consensus	Establish guidelines to work with patients infected with 2019-nCoV.	If a patient who tested positive for COVID-19 develops ARDS, the adoption of invasive mechanical ventilation combined with prone positioning is necessary.	5b
A3⁽¹⁴⁾	Canada	Expert consensus	Serve as the basis to optimize supportive care for patients with COVID-19.	The implementation of PP is strongly recommended for adult patients with COVID-19, though it requires sufficient human resources and appropriate knowledge.	5b
A4⁽¹⁵⁾	Saudi Arabia	Narrative review	Describe the management of patients with ARDS caused by COVID.	Prone positioning, implemented among patients with severe ARDS, was associated with improved oxygenation, which was sustained after returning to the supine position.	n/e^‡ ‡ n/e = no evidence
A5⁽¹⁶⁾	Italy	Prospective cohort	Report the experience of a hospital with patients with COVID-19.	PP is suggested as an early treatment for COVID-19.	3c
A6⁽¹⁷⁾	Brazil	Expert consensus	PP in the treatment of acute respiratory distress in COVID-19.	Even though PP is a resource that improves oxygenation, caution is recommended when prescribing this positioning during the COVID-19 pandemic.	5b
A7⁽¹⁸⁾	United Kingdom	Expert consensus	Develop a flowchart to identify the benefits of prone positioning among patients with COVID-19.	Given the potential of PP to improve the oxygenation of patients with COVID-19, its use is recommended for all suitable and conscious patients in the ward.	5b
A8⁽¹⁹⁾	USA	Literature review	Describe the role of PP among patients with COVID-19.	The prone positioning can contribute to decrease mortality if implemented in the first hours after the manifestation of the disease.	n/e^‡ ‡ n/e = no evidence
A9⁽²⁰⁾	Spain	Expert consensus	Share information regarding the treatment of patients infected with COVID-19.	The prone position improves the ventilation/perfusion ratio and prognosis. Some complications should be prevented though.	5b
A10⁽²¹⁾	USA	Literature review	Describe the clinical management of respiratory complications caused by COVID-19.	PP improves the ventilation/perfusion ratio, contributing to decrease mortality rates caused by the novel Coronavirus.	n/e^‡ ‡ n/e = no evidence
A11⁽²²⁾	USA	Literature review	Disseminate a protocol regarding the clinical management of patients with sepsis caused by SARS-CoV-2.	The use of a POP is recommended to place patients in the prone position in all institutions. One should be attentive to absolute counter-indications.	n/e^‡ ‡ n/e = no evidence
A12⁽²³⁾	Costa Rica	Scoping Review	Establish a guide for Nursing care provided to patients with COVID-19 in the prone position.	The prone positioning is an efficient alternative in the treatment of individuals with ARDS caused by COVID-19. Therefore, professional management is essential to provide quality nursing care to decrease complications and adverse events.	n/e^‡ ‡ n/e = no evidence

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Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
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[TFN1] ^*
ID = Identification;

[TFN2] ^†
LE = Level of evidence;

[TFN3] ^‡
n/e = no evidence

Prone positioning as an emerging tool in the care provided to patients infected with COVID-19: a scoping review*

Prone positioning as an emerging tool in the care provided to patients infected with COVID-19: a scoping review^*