Objective To develop and implement prone positioning program for awake patients,and explore the feasibility and effeteness of prone positioning in awake patients. Methods The multidisciplinary treatment team was set up to develop the prone positioning program,including treatment decision of awake prone position timing,prone positioning schedule making with patients,prone position safety and tolerance assessment,position replacement scheme to improve tolerance,individualized time accumulation system,and prone position knowledge education and psychological support. The preliminary application was carried out in awake COVID-19 patients admitted to a designated hospital in Fujian province in September 2021. Results 136 patients were treated with awake prone positioning program,the average duration were （11.95±2.47）h. The prone positioning tolerability scores were significantly improved one week after hospital admission（t=35.254,P<0.05）. 133 patients recovered and 3 patients（2.2%）developed to critical illness,the average of hospitalization length was （14.95±3.02）days without serious adverse events during prone positioning. The oxygenation index of patients were significantly improved（F=5.624,P<0.05）. Conclusion The awake prone positioning program based on multidisciplinary treatment team cooperation is feasible and practical,which can provide a reference for the improvement of lung ventilation in clinical practice.
HE Jinyi
,
CHEN Meirong
,
CHEN Xiaohuan
,
CHEN Lili
,
YE Yan
,
ZHOU Xiaofen
,
XIE Shaohua
,
LI Hong
. Research on the development and practice of prone positioning program for awake patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023
, 4(4)
: 309
-314
.
DOI: 10.3761/j.issn.2096-7446.2023.04.004
[1] Munshi L,Del Sorbo L,Adhikari NKJ,et al.Prone position for acute respiratory distress syndrome. A systematic review and Meta-analysis[J]. Ann Am Thorac Soc,2017,14(Supplement_4):S280-S288.
[2] Lucchini A,Bambi S,Mattiussi E,et al.Prone position in acute respiratory distress syndrome patients:a retrospective analysis of complications[J]. Dimens Crit Care Nurs,2020,39(1):39-46.
[3] Guérin C,Albert RK,Beitler J,et al.Prone position in ARDS patients:why,when,how and for whom[J]. Intensive Care Med,2020,46(12):2385-2396.
[4] Bentley SK,Iavicoli L,Cherkas D,et al.Guidance and patient instructions for proning and repositioning of awake,nonintubated COVID-19 patients[J]. Acad Emerg Med,2020,27(8):787-791.
[5] Rampon GL,Simpson SQ,Agrawal R.Prone positioning for acute hypoxemic respiratory failure and ARDS:a review[J]. Chest,2023,163(2):332-340.
[6] 中华人民共和国国家卫生健康委员会. 新型冠状病毒肺炎诊疗方案(试行第八版修订版)[J]. 中华临床感染病杂志,2021,14(2):81-88.
National Health Commission.Diagnosis and treatment plan for COVID-19(trial version 8 revision)[J]. Chin J Clin Infect Dis,2021,14(2):81-88.
[7] Coppo A,Bellani G,Winterton D,et al.Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19(PRON-COVID):a prospective cohort study[J]. Lancet Respir Med,2020,8(8):765-774.
[8] Thompson AE,Ranard BL,Wei Y,et al.Prone positioning in awake,nonintubated patients with COVID-19 hypoxemic respiratory failure[J]. JAMA Intern Med,2020,180(11):1537-1539.
[9] 金静芬,宋剑平,赵锐祎,等. 综合医院护理部应对新型冠状病毒肺炎的管理策略[J]. 中华急危重症护理杂志,2020,1(2):113-117.
Jin JF,Song JP,Zhao RY,et al.The nursing management strategies of general hospital for the sudden outbreak of COVID-19[J]. Chin J Emerg Crit Care Nurs,2020,1(2):113-117.
[10] 陈然,王瑜,余建英,等. PHQ-9在综合医院住院患者中信效度研究[J]. 四川精神卫生,2017,30(2):149-153.
Chen R,Wang Y,Yu JY,et al.Evaluation of the reliability and validity of PHQ-9 in general hospital inpatients[J]. Sichuan Ment Health,2017,30(2):149-153.
[11] 吴欣娟,孙红,李奇,等. 新型冠状病毒肺炎ICU护理人员应掌握的核心技术与流程要求[J]. 中华急危重症护理杂志,2020, 1(2):121.
Wu XJ,Sun H,Li Q,et al.Core skills and process requirements for nursing staff of COVID-19 ICU[J]. Chin J Emerg Crit Care Nurs,2020,1(2):121.
[12] Fan E,Del Sorbo L,Goligher EC,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[J]. Am J Respir Crit Care Med,2017,195(9):1253-1263.
[13] 任成山,林辉,杨仕明,等. 冠状病毒及新型冠状病毒肺炎防控策略[J]. 中华肺部疾病杂志(电子版),2020,13(1):1-5.
Ren CS,Lin H,Yang SM,et al.Prevention and control strategies of coronavirus and novel coronavirus pneumonia[J]. Chin J Lung Dis Electron Ed,2020,13(1):1-5.
[14] 梁志伟,罗傲,温春燕,等. 新型冠状病毒肺炎病情进展为重型/危重型的危险因素研究[J]. 国际流行病学传染病学杂志,2020,47(3):191-195.
Liang ZW,Luo A,Wen CY,et al.Risk factors to predict the occurrence of critical illness in patients with COVID-19[J]. Int J Epidemiol Infect Dis,2020,47(3):191-195.
[15] Wu ZY,McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019(COVID-19）outbreak in China:summary of a report of 72 314 cases from the Chinese center for disease control and prevention[J]. JAMA,2020,323(13):1239-1242.
[16] 钱洁,任致群,于德华,等. 患者健康问卷躯体症状群量表在综合医院的筛检价值[J]. 中国心理卫生杂志,2014,28(3):173-178.
Qian J,Ren ZQ,Yu DH,et al.The value of the Patient Health Questionnaire-15(PHQ-15）for screening somatic symptoms in general hospital[J]. Chin Ment Health J,2014,28(3):173-178.
[17] 卞崔冬,何筱衍,钱洁,等. 患者健康问卷抑郁症状群量表在综合性医院中的应用研究[J]. 同济大学学报(医学版),2009,30(5):136-140.
Bian CD,He XY,Qian J,et al.The reliability and validity of a modified patient health questionnaire for screening depressive syndrome in general hospital outpatients[J]. J Tongji Univ Med Sci,2009,30(5):136-140.
