| Penulis/Author |
dr. Siswanto, Sp.P(K) (1); dr. Oktaviarum Slamet Utama (2); dr. Guritno Adistyawan, Sp.KFR. (3); Purwadi Sujalmo, S.Kep., Ners., M.Kep. (4) ; GUSTI PUTRI DEVANY T (5); PRIMAVERA NABILA S (6); TAUFIQ ROHMAN (7); Prof. Dr. dr. Denny Agustiningsih, M.Kes., AIFM. (8) |
| Abstrak/Abstract |
Abstract
Introduction: Prone positioningis one type of postural lung recruitment maneuver that gives benefits and physiological changes of the cardiorespiratory system. However, prone positioning is not very comfortable for the patients because they have to lie on their stomachs. Based on patient observations, some patients will change positions more comfortably, namely using the right / left lateral decubitus position. This study aims to investigate the physiological effect of prone positioning (PP) and lateral decubitus (LD) in non-intubated severe COVID-19 patients in Indonesia.
Methods: This was a prospective cohort study in patients with severe COVID-19 who received a non-rebreathing mask or high flow nasal cannula in the UGM Academic Hospital from 1 June to 10 September 2021. The patient conducted PP or LD every morning and afternoon for 4 hours and measured cardiorespiratory parameters and blood gas analysis.
Result: Total of 48 patients with a confirmed diagnosis of severe COVID-19 were included in the study, about 14 (29.1%) received PP and 34 (70.83%) had LD. The considerable number of patients 13 (27.08%) gotten HFNC. There was a gradual increase between after 4 hours PP or LD in the morning to after 4 hours PP or LD in the afternoon in SpO2/FiO2 118.5 (IQR 94.4-291.2) to 119.9 (IQR 91.0-241.5) and PaO2/FiO2 94.9 (IQR 37.6-513.8) to 117.3 (IQR 85.0-239.0) and also decrease AaDO2 464.5 (26.0-621.0) to 444.5 (95.0-620.0) with no statistical significance. There were significant differences of mean arterial pressure (MAP) in early observation at 6-8 am supine showed PP groups 84.4 (SD 10.6) vs LD groups 93.6 (SD 14.4) with p=0.037) and at 8-12 am showed PP groups 88.7 (SD 8.7) vs LD groups 100.2 (SD 13.8) with p=0.006. But there were no significant differences in MAP at 0-2 pm supine, 2-6 pm PP/LD and 6-8 pm supine observation. No significant differences were observed in cardiorespiratory parameters (heart rate, respiratory rate, SpO2) and blood gas analysis parameters (pH, PaO2, PaCO2, SaO2, PaO2/FiO2 ratio, and AaDO2) between PP and LD. Conclusion: The physiological effect of prone positioning and lateral decubitus in non-intubated severe COVID-19 patients are similar. The lateral decubitus can be an alternative for postural lung recruitment maneuvers and warrants further randomized trials
Keywords: COVID-19, prone positioning, lateral decubitus, physiological effect, postural lung recruitment maneuver (PLRM)
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