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Review
. 2024 Jan-Dec:18:17534666231219630.
doi: 10.1177/17534666231219630.

Prone positioning during CPAP therapy in SARS-CoV-2 pneumonia: a concise clinical review

Chiara Chiappero  1 , Alessio Mattei  2 , Luca Guidelli  3 , Serena Millotti  4 , Emiliano Ceccherini  4 , Simon Oczkowski  5   6 , Raffaele Scala  3
Affiliations
Review

Prone positioning during CPAP therapy in SARS-CoV-2 pneumonia: a concise clinical review

Chiara Chiappero et al. Ther Adv Respir Dis. 2024 Jan-Dec.

Abstract

During the COVID-19 pandemic, the number of patients with hypoxemic acute respiratory failure (ARF) due to SARS-CoV-2 pneumonia threatened to overwhelm intensive care units. To reduce the need for invasive mechanical ventilation (IMV), clinicians tried noninvasive strategies to manage ARF, including the use of awake prone positioning (PP) with continuous positive airway pressure (CPAP). In this article, we review the patho-physiologic rationale, clinical effectiveness and practical issues of the use of PP during CPAP in non-intubated, spontaneously breathing patients affected by SARS-CoV-2 pneumonia with ARF. Use of PP during CPAP appears to be safe and feasible and may have a lower rate of adverse events compared to IMV. A better response to PP is observed among patients in early phases of acute respiratory distress syndrome. While PP during CPAP may improve oxygenation, the impact on the need for intubation and mortality remains unclear. It is possible to speculate on the role of PP during CPAP in terms of improvement of ventilation mechanics and reduction of strain stress.

Keywords: SARS-CoV-2; acute respiratory failure; continuous positive airway pressure; non-invasive positive pressure ventilation; pronation; prone position.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Prone positioning-induced physiologic benefits.
Figure 2.
Figure 2.
Patient in prone position receiving CPAP delivered by the helmet. The comfort of the patient got better with a small pillow under the chest and another one under the head. CPAP, continuous positive airway pressure.
See this image and copyright information in PMC

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