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VOLUME 10 , ISSUE 1 ( January-April, 2021 ) > List of Articles

CASE SERIES

Utility of Awake Prone Positioning with Low-Dose Systemic Corticosteroids in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome Patients: A Case Series

N. R. Arjun, Nitin Gupta, Shashikiran Umakanth, Kavitha Saravu

Keywords : Acute respiratory distress syndrome, awake prone positioning, coronavirus disease 2019, corticosteroids

Citation Information : Arjun NR, Gupta N, Umakanth S, Saravu K. Utility of Awake Prone Positioning with Low-Dose Systemic Corticosteroids in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome Patients: A Case Series. Indian J Respir Care 2021; 10 (1):100-106.

DOI: 10.4103/ijrc.ijrc_66_20

License: CC BY-NC-SA 4.0

Published Online: 06-12-2022

Copyright Statement:  Copyright © 2021; Indian Journal of Respiratory Care.


Abstract

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2, novel enveloped RNA beta-coronavirus. The clinical manifestations vary from no symptoms to fever, cough, respiratory distress, pneumonia, and adult respiratory distress syndrome (ARDS) or uncommonly diarrhea. Typically, the disease has viremic phase, pulmonary phase, and severe host inflammatory phase. Prompt interventions in the first two phases such as awake prone positioning and administration of low-dose corticosteroids can prevent the onset of the third phase of the deadly disease. Awake prone positioning and systemic corticosteroids are simple interventions, which can prevent the requirement of mechanical ventilation and also lead to reduction in the inflammatory response and disease severity. We report a case series of six patients who diagnosed with COVID-19 ARDS and were benefitted by awake prone positioning sessions and low-dose systemic corticosteroid therapy.


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  1. Liu Q, Wang RS, Qu GQ, Wang YY, Liu P, Zhu YZ, et al. Gross examination report of a COVID-19 death autopsy. Fa Yi Xue Za Zhi 2020;36:21-3.
  2. Xu Q, Wang T, Qin X, Jie Y, Zha L, Lu W. Early awake prone position combined with high-flow nasal oxygen therapy in severe COVID-19: A case series. Crit Care 2020;24:250.
  3. Albert RK, Hubmayr RD. The prone position eliminates compression of the lungs by the heart. Am J Respir Crit Care Med 2000;161:1660-5.
  4. Ng Z, Tay WC, Ho CH. Awake prone positioning for non-intubated oxygen dependent COVID-19 pneumonia patients. Eur Respir J 2020;56:2001198.
  5. Thompson AE, Ranard BL, Wei Y, Jelic S. Prone Positioning in Awake, Nonintubated Patients With COVID-19 Hypoxemic Respiratory Failure. JAMA Intern Med. Published online June 17, 2020. doi:10.1001/jamainternmed.2020.3030.
  6. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368:2159-68.
  7. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020;180:1-11.
  8. Wang Y, Jiang W, He Q, Wang C, Wang B, Zhou P, et al. A retrospective cohort study of methylprednisolone therapy in severe patients with COVID-19 pneumonia. Signal Transduct Target Ther 2020;5:57.
  9. Greos LS, Vichyanond P, Bloedow DC, Irvin CG, Larsen GL, Szefler SJ, et al. Methylprednisolone achieves greater concentrations in the lung than prednisolone. A pharmacokinetic analysis. Am Rev Respir Dis 1991;144:586-92.
  10. Horby P, Lim WS, Emberson J, Mafham M, Bell J, Linsell L, et al. Effect of dexamethasone in hospitalized patients with COVID-19: Preliminary report. medRxiv; 2020. Available from: https://www.medrxiv.org/content/early/2020/06/22/2020.06.22.20137273. [Last accessed on 2020 Aug 14].
  11. Dagens A, Sigfrid L, Cai E, Lipworth S, Cheng V, Harris E, et al. Scope, quality, and inclusivity of clinical guidelines produced early in the COVID-19 pandemic: Rapid review. BMJ 2020;369:m1936.
  12. Zhao JP, Hu Y, Du RH, Chen ZS, Jin Y, Zhou M, et al. Expert consensus on the use of corticosteroid in patients with 2019-nCoV pneumonia. Zhonghua Jie He He Hu Xi Za Zhi 2020;43:183-4.
  13. Meduri GU, Siemieniuk RA, Ness RA, Seyler SJ. Prolonged low-dose methylprednisolone treatment is highly effective in reducing duration of mechanical ventilation and mortality in patients with ARDS. J Intensive Care 2018;6:53.
  14. Ministry of Health and Family Welfare. Clinical Management Protocol: COVID 19; 2020. Available from: https://www.mohfw.gov.in/pdf/UpdatedClinicalManagementProtocolforCOVID19dated03072020.pdf. [Last accessed on 2020 Aug 14].
  15. Giannis D, Ziogas IA, Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol 2020;127:104362.
  16. Atallah B, Mallah SI, AlMahmeed W. Anticoagulation in COVID-19. Eur Heart J Cardiovasc Pharmacother 2020;6:260-1.
  17. Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis 2020;50:72-81.
  18. Susen S, Tacquard CA, Godon A, Mansour A, Garrigue D, Nguyen P, et al. Prevention of thrombotic risk in hospitalized patients with COVID-19 and hemostasis monitoring. Crit Care 2020;24:364.
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