Analysis of influencing factors of the awake prone position in patients with mild and moderate acute respiratory distress syndrome_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIAO Shunqi , YUE Yan , ZHOU Xiujuan , XIANG Mengling ,  GAO Peiyang

Department of Critical Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610000, P. R. China;

Corresponding?author：

GAO Peiyang, Email: gaopy930@126.com

Keywords：

Acute respiratory distress syndrome; prone position; awake prone position; impact factor

DOI：

10.7507/1671-6205.202303019

Video：

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Objective To investigate the current status and influencing factors of the awake prone position in patients with mild and moderate acute respiratory distress syndrome (ARDS). Methods A total of 210 patients with mild to moderate ARDS admitted between December 2022 and January 2023 were investigated by general information questionnaire and self-made prone position knowledge questionnaire. The daily prone position time during hospitalization was recorded. The influencing factors of awake prone position were analyzed by univariate and multivariate linear regression. Results The 210 mild and moderate ARDS patients had an average daily prone position length of stay of (4.97±3.94)h/d, showing a low level. Multiple linear regression analysis showed that prone position knowledge score, age, waist circumference and BMI were the influencing factors of awake prone position (P<0.05). Conclusions Daily awake prone position length was at a low level in mild and moderate ARDS patients. Healthcare workers can prolong the time in the prone position by developing an individualized treatment plan for the prone position, improving the patient’s perception of the prone position, and resolving the discomfort from the prone position.

Citation： LIAO Shunqi, YUE Yan, ZHOU Xiujuan, XIANG Mengling, GAO Peiyang. Analysis of influencing factors of the awake prone position in patients with mild and moderate acute respiratory distress syndrome. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(12): 873-877. doi: 10.7507/1671-6205.202303019 Copy

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2.	Ehrmann S, Li J, Ibarra-Estrada M, et al. 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.
3.	Lucchini A, Russotto V, Barreca N, et al. Short and long-term complications due to standard and extended prone position cycles in COViD-19 patients. Intensive Crit Care Nurs, 2022, 69: 103158.
4.	Fazzini B, Page A, Pearse R, et al. Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Br J Anaesth, 2022, 128(2): 352-362.
5.	張勤芹, 唐誠, 繆翠維, 等. 早期清醒俯臥位聯合經鼻高流量氧療對輕中度ARDS患者的研究. 臨床肺科雜志, 2022, 27(6): 858-861.
6.	岳偉崗, 張瑩, 蔣由飛, 等. 俯臥位通氣對急性呼吸窘迫綜合征患者的影響. 中國呼吸與危重監護雜志, 2019, 18(6): 532-536.
7.	Jayakumar D, Ramachandran Dnb P, Rabindrarajan Dnb E, et al. Standard care versus awake prone position in adult nonintubated patients with acute hypoxemic respiratory failure secondary to COVID-19 infection--a multicenter feasibility randomized controlled trial. J Intensive Care Med, 2021, 36(8): 918-924.
8.	漆敏, 倪忠, 唐永江, 等. 清醒俯臥位通氣策略在低氧性呼吸衰竭患者中的應用進展. 中國呼吸與危重監護雜志, 2021, 20(3): 215-218.
9.	王志勇, 馮全勝, 于洪志, 等. 清醒俯臥位治療用于奧密克戎變異株所致普通型新冠肺炎的臨床研究. 中華危重病急救醫學, 2022, 34(6): 576-580.
10.	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
11.	蔣燕, 陸葉, 蔣旭琴, 等. 成人急性呼吸窘迫綜合征患者俯臥位通氣管理的最佳證據總結. 中華護理雜志, 2022, 57(15): 1878-1885.
12.	Qian ET, Gatto CL, Amusina O, et al. Assessment of awake prone positioning in hospitalized adults with COVID-19: a nonrandomized controlled trial. JAMA Intern Med, 2022, 182(6): 612-621.
13.	段均. 急性呼吸窘迫綜合征患者機械通氣指南(試行)解讀. 重慶醫科大學學報, 2017, 42(1): 76-78.
14.	Fan E, Del Sorbo L, Goligher E C, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir CritCare Med, 2017, 195(9): 1253-1263.
15.	郝培育, 李秋萍. ICU護士俯臥位通氣知信行現狀及影響因素分析. 護理學雜志, 2022, 37(20): 84-86.
16.	Poor AD, Acquah SO, Wells CM, et al. Implementing automated prone ventilation for acute respiratory distress syndrome via simulation-based training. Am Crit Care, 2020, 29(3): e52-e59.
17.	趙小莉, 劉學勤. TDP照射和香薰理療對提高視網膜脫離術后俯臥位患者舒適度的效果評價. 當代護士(下旬刊), 2016(12): 1-3.
18.	Alhazzani W, Parhar KKS, Weatherald J, 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): 2104-2113.
19.	朱鴻丹. AECOPD合并肺栓塞的臨床特征及與BMI的關系研究. 昆明醫科大學, 2022.
20.	Li J, Luo J, Pavlov I, et al. Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Lancet Respir Med, 2022, 10(6): 573-583.
21.	Carsetti A, Damia Paciarini A, Marini B, et al. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective. Crit Care, 2020, 24(1): 225.
22.	Cornejo RA, Montoya J, Gajardo AIJ, et al. Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile. Ann Intensive Care, 2022, 12(1): 109.
23.	張雨, 劉芳麗, 高孟娟, 等. 癡呆病人居家照顧者心理靈活性現狀及影響因素. 護理研究, 2022, 36(23): 4287-4291.
24.	王琛. 優勢內容遞增教育法對乳腺癌化療患者癌因性疲乏的影響. 武漢輕工大學, 2023.
25.	孔娜. 老年社會工作的倫理困境及應對原則. 倫理學研究, 2015(2): 123-126.
26.	岳偉崗. 俯臥位通氣對急性呼吸窘迫綜合征患者的Meta分析及臨床研究. 蘭州大學, 2018.

1. Meyer NJ, Gattinoni L, Calfee CS. Acute respiratory distress syndrome. Lancet, 2021, 398(10300): 622-637.
2. Ehrmann S, Li J, Ibarra-Estrada M, et al. 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.
3. Lucchini A, Russotto V, Barreca N, et al. Short and long-term complications due to standard and extended prone position cycles in COViD-19 patients. Intensive Crit Care Nurs, 2022, 69: 103158.
4. Fazzini B, Page A, Pearse R, et al. Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Br J Anaesth, 2022, 128(2): 352-362.
5. 張勤芹, 唐誠, 繆翠維, 等. 早期清醒俯臥位聯合經鼻高流量氧療對輕中度ARDS患者的研究. 臨床肺科雜志, 2022, 27(6): 858-861.
6. 岳偉崗, 張瑩, 蔣由飛, 等. 俯臥位通氣對急性呼吸窘迫綜合征患者的影響. 中國呼吸與危重監護雜志, 2019, 18(6): 532-536.
7. Jayakumar D, Ramachandran Dnb P, Rabindrarajan Dnb E, et al. Standard care versus awake prone position in adult nonintubated patients with acute hypoxemic respiratory failure secondary to COVID-19 infection--a multicenter feasibility randomized controlled trial. J Intensive Care Med, 2021, 36(8): 918-924.
8. 漆敏, 倪忠, 唐永江, 等. 清醒俯臥位通氣策略在低氧性呼吸衰竭患者中的應用進展. 中國呼吸與危重監護雜志, 2021, 20(3): 215-218.
9. 王志勇, 馮全勝, 于洪志, 等. 清醒俯臥位治療用于奧密克戎變異株所致普通型新冠肺炎的臨床研究. 中華危重病急救醫學, 2022, 34(6): 576-580.
10. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
11. 蔣燕, 陸葉, 蔣旭琴, 等. 成人急性呼吸窘迫綜合征患者俯臥位通氣管理的最佳證據總結. 中華護理雜志, 2022, 57(15): 1878-1885.
12. Qian ET, Gatto CL, Amusina O, et al. Assessment of awake prone positioning in hospitalized adults with COVID-19: a nonrandomized controlled trial. JAMA Intern Med, 2022, 182(6): 612-621.
13. 段均. 急性呼吸窘迫綜合征患者機械通氣指南(試行)解讀. 重慶醫科大學學報, 2017, 42(1): 76-78.
14. Fan E, Del Sorbo L, Goligher E C, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir CritCare Med, 2017, 195(9): 1253-1263.
15. 郝培育, 李秋萍. ICU護士俯臥位通氣知信行現狀及影響因素分析. 護理學雜志, 2022, 37(20): 84-86.
16. Poor AD, Acquah SO, Wells CM, et al. Implementing automated prone ventilation for acute respiratory distress syndrome via simulation-based training. Am Crit Care, 2020, 29(3): e52-e59.
17. 趙小莉, 劉學勤. TDP照射和香薰理療對提高視網膜脫離術后俯臥位患者舒適度的效果評價. 當代護士(下旬刊), 2016(12): 1-3.
18. Alhazzani W, Parhar KKS, Weatherald J, 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): 2104-2113.
19. 朱鴻丹. AECOPD合并肺栓塞的臨床特征及與BMI的關系研究. 昆明醫科大學, 2022.
20. Li J, Luo J, Pavlov I, et al. Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Lancet Respir Med, 2022, 10(6): 573-583.
21. Carsetti A, Damia Paciarini A, Marini B, et al. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective. Crit Care, 2020, 24(1): 225.
22. Cornejo RA, Montoya J, Gajardo AIJ, et al. Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile. Ann Intensive Care, 2022, 12(1): 109.
23. 張雨, 劉芳麗, 高孟娟, 等. 癡呆病人居家照顧者心理靈活性現狀及影響因素. 護理研究, 2022, 36(23): 4287-4291.
24. 王琛. 優勢內容遞增教育法對乳腺癌化療患者癌因性疲乏的影響. 武漢輕工大學, 2023.
25. 孔娜. 老年社會工作的倫理困境及應對原則. 倫理學研究, 2015(2): 123-126.
26. 岳偉崗. 俯臥位通氣對急性呼吸窘迫綜合征患者的Meta分析及臨床研究. 蘭州大學, 2018.

Chinese Journal of Respiratory and Critical Care Medicine

Analysis of influencing factors of the awake prone position in patients with mild and moderate acute respiratory distress syndrome

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