Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: A retrospective study.
OBJECTIVE
Prone positioning (PP) improves oxygenation and outcome of patients with acute respiratory distress syndrome undergoing invasive ventilation. We evaluated feasibility and efficacy of PP in awake, non-intubated, spontaneously breathing patients with hypoxemic acute respiratory failure (ARF).


METHODS
We retrospectively studied non-intubated subjects with hypoxemic ARF treated with PP from January 2009 to December 2014. Data were extracted from medical records. Arterial blood gas analyses, respiratory rate, and hemodynamics were retrieved 1 to 2 hours before pronation (step PRE), during PP (step PRONE), and 6 to 8 hours after resupination (step POST).


RESULTS
Fifteen non-intubated ARF patients underwent 43 PP procedures. Nine subjects were immunocompromised. Twelve subjects were discharged from hospital, while 3 died. Only 2 maneuvers were interrupted, owing to patient intolerance. No complications were documented. PP did not alter respiratory rate or hemodynamics. In the subset of procedures during which the same positive end expiratory pressure and Fio2 were utilized throughout the pronation cycle (n=18), PP improved oxygenation (Pao2/Fio2 124±50 mmHg, 187±72 mmHg, and 140±61 mmHg, during PRE, PRONE, and POST steps, respectively, P<.001), while pH and Paco2 were unchanged.


CONCLUSIONS
PP was feasible and improved oxygenation in non-intubated, spontaneously breathing patients with ARF.
Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy. Electronic address: vittorio.scaravilli@gmail.com.
Vittorio
V
Scaravilli
Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy.
Giacomo
G
Grasselli
Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.
Luigi
L
Castagna
Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.
Alberto
A
Zanella
Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy.
Stefano
S
Isgrò
Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy.
Alberto
A
Lucchini
Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy; Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy.
Nicolò
N
Patroniti
Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy; Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy.
Giacomo
G
Bellani
Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy; Dipartimento di Emergenza e Urgenza, Ospedale San Gerardo, Via Pergolesi 33, 20900, Monza, MB, Italy.
Antonio
A
Pesenti
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000502:physiology*; D011175:Positive-Pressure Respiration / Q000379:methods*; D016684:Prone Position; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000150:complications; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D010100:Oxygen
Hypoxia; Noninvasive ventilation; Prone position; Pulmonary gas exchange; Pulmonary ventilation; Retrospective studies