In recent years, prone mechanical ventilation has been widely used to improve oxygenation dysfunction in critically ill patients. During prone mechanical ventilation, the patient's face is compressed for a long time, and due to the difficulty in changing, facial pressure injuries and ocular complications are common and severe. These complications increase patient discomfort, reduce their tolerance and compliance with prone ventilation, and even cause tracheal tube displacement or dislodgement, leading to significant clinical challenges. In order to change this situation, the medical staff of the department of critical care medicine of the Second People's Hospital of Hengshui and the department of critical care medicine of Harrison International Peace Hospital had developed an adjustable facial support pad for prone ventilation, and obtained a National Utility Model Patent of China (ZL 2022 2 3295294.4). The device is composed of a facial support platform, a supporting telescopic foot frame and so on. There are front, back, left and right adjustable tracks below the support cushion platform, which can be adjusted to the best state suitable for the patient's face shape, which can alleviate the facial pressure injuries and ocular complications caused by the different sizes of each patient's face, improve the patient's comfort, and reduce the incidence of facial pressure injury and the occurrence of ocular complications of the patient. The height of the platform is adjusted by the telescopic feet, and there is a hook assembly below, which can be fixed by the clamp of the ventilator tubing, so as to prevent the ventilator tubing from pulling the endotracheal intubation due to the gravity of condensation, resulting in the displacement or even prolapse of the tracheal intubation, and reducing the occurrence of adverse events of tracheal intubation. It is worth promoting in the clinic.
Humans ; Respiration, Artificial/methods* ; Prone Position ; Equipment Design ; Face

Prone position ventilation (PPV) is an important protective strategy for lung ventilation, widely used in clinical practice, especially since the novel coronavirus infection pandemic. Since PPV is a non-physiological position, improper implementation and management can lead to serious adverse events such as pressure injury, facial edema, unplanned extubation and (or) reintubation, and even asphyxia. At present, preventive and protective strategies are mainly used to manage PPV-related complications in clinical practice. These strategies not only increase the workload of medical staff and the use of consumables, but also increase the medical cost of patients, further burdening patients and their families economically. To overcome the above problems, the medical staff of the department of critical care medicine of Tianjin Third Central Hospital designed a prone position head auxiliary support device and obtained a national utility model patent (patent number: ZL 2022 2 1751906.3). The device consists of annular plate, folding plate, support frame, reflector and wheel bodies. It serves to reduce pressure on the head and facial skin, while also exposing the mouth, nose, eyes, and ears to the hollow position of the annular plate according to the patient's position. At the same time, the patient's face or side skin can be observed through the lower reflector. The height of the annular plate was adjusted by adjusting the support frame, and the head was raised to reduce facial edema. The setting of strip groove, through hole and hook can sort out the facial pipeline, keep the drainage unobstructed, prevent catheter displacement and unplanned extubation, and has certain clinical promotion and practical value.
Humans ; Prone Position ; Equipment Design ; Respiration, Artificial/methods* ; COVID-19 ; Head ; Patient Positioning

Prone position ventilation (PPV) has been widely used in the treatment strategy of patients with acute respiratory distress syndrome (ARDS). Patients undergoing PPV may develop facial edema and are at risk for pressure injuries due to prolonged prone positioning. In clinical practice, preventive measures such as repositioning, protective dressings, and pressure-relief cushions are commonly used to prevent pressure injuries. However, factors such as improper endotracheal tube placement, self-paid dressings, and delayed clearance of oral and nasal secretions have reduced the effectiveness of preventing facial pressure injuries. To address the above issues, a device for preventing pressure injuries on the faces of patients in the prone position was designed by healthcare workers in the nursing department of Dalian Friendship Hospital, and a National Utility Model Patent of China was obtained (ZL 2024 2 0340439.8). The device consists of a support plate and a circuit control system. The support plate is equipped with two support members. Support member 1 is directly fixed to the support plate, while support member 2 is connected to the support plate via a slide and a spiral rod, serving to support the patient's face and allowing for adjustment of the appropriate width according to the size of the patient's face. Inside the two support members, there are several telescopic rods, with the upper ends designed as spherical supports. The height and position of the telescopic components can be adjusted through a circuit control system, regularly changing the pressure distribution on the patient's face, thereby achieving the purpose of changing the pressure points on the face. The inner wall of support member 2 is equipped with a camera, allowing direct observation of the patient's facial condition through a monitor, avoiding compression of the eyes and nose, and promptly removing secretions from the mouth to keep the face clean, thereby reducing the risk of facial pressure-related injuries. The center of the two support members features a hollow slot, facilitating the placement of a tracheal tube. The circuit control system includes a random module, a time setting module, a control module, and a drive module. Parameters can be set as needed. When the shortest set time is reached, the random module and time setting module send instructions to the control module. Upon receiving the instructions from the time setting module and the random number from the random module, the control module transmits information to the drive module. The drive module, upon receiving the information, controls multiple telescopic rods to adjust their height and position, thereby changing the support points on the patient's face. The device features a simple structure and convenient operation, allowing for flexible adaptation to the patient's facial shape. It can be replaced with the patient's facial pressure area, providing an intuitive view of the patient's facial pressure situation. With automation and high safety, it helps reduce the risk of pressure-related injuries and lightens the workload of medical staff.
Humans ; Pressure Ulcer/prevention & control* ; Prone Position ; Equipment Design ; Facial Injuries/prevention & control* ; Respiration, Artificial/instrumentation* ; Respiratory Distress Syndrome/therapy*

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) infection posed a huge threat and burden to public healthcare in late 2022. Non-drug measures of traditional Chinese medicine (TCM), such as acupuncture, cupping and moxibustion, are commonly used as adjuncts in China to help in severe cases, but their effects remain unclear. OBJECTIVES: To observe the clinical effect of TCM non-drug measures in improving respiratory function and symptoms among patients with severe COVID-19. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This study was designed as a multicenter, assessor-blind, randomized controlled trial. Hospitalized patients with COVID-19 were randomly assigned to the treatment or control group. The treatment group received individualized TCM non-drug measures in combination with prone position ventilation, while the control group received prone position ventilation only for 5 consecutive days. MAIN OUTCOME MEASURES: The primary outcome measures were the percentage of patients with improved oxygen saturation (SpO₂) at the end of the 5-day intervention, as well as changes of patients' respiratory rates. The secondary outcome measures included changes in SpO₂ and total score on the self-made respiratory symptom scale. The improvement rate, defined as a 3-day consecutive increase in SpO₂, the duration of prone positioning, and adverse events were recorded as well. RESULTS: Among the 198 patients included in the intention-to-treat analysis, 159 (80.3%) completed all assessments on day 5, and 39 (19.7%) patients withdrew from the study. At the end of the intervention, 71 (91%) patients in the treatment group had SpO₂ above 93%, while 61 (75.3%) in the control group reached this level. The proportion of participant with improved SpO₂ was significantly greater in the intervention group (mean difference [MD] = 15.7; 95% confidence interval [CI]: 4.4, 27.1; P = 0.008). Compared to the baseline, with daily treatment there were significant daily decreases in respiratory rates in both groups, but no statistical differences between groups were found (all P ≥ 0.05). Compared to the control group, the respiratory-related symptoms score was lower among patients in the treatment group (MD = -1.7; 95% CI: -2.8, -0.5; P = 0.008) after day 3 of treatment. A gradual decrease in the total scores of both groups was also observed. Thirty-one adverse events occurred during the intervention, and 2 patients were transferred to the intensive care unit due to deterioration of their illness. CONCLUSION: TCM non-drug measures combined with prone positioning can effectively treat patients with severe COVID-19. The combined therapy significantly increased SpO₂ and improved symptom scores compared to prone positioning alone, thus improving the patients' respiratory function to help them recover. However, the improvement rate did not differ between the two groups. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2300068319). Please cite this article as: Yin X, Jin Z, Li F, Huang L, Hu YM, Zhu BC, Wang ZQ, Li XY, Li JP, Lao LX, Mi YQ, Xu SF. Effectiveness and safety of adjunctive non-drug measures in improving respiratory symptoms among patients with severe COVID-19: A multicenter randomized controlled trial. J Integr Med. 2024; 22(6): 637-644.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Acupuncture Therapy/methods* ; China ; COVID-19/complications* ; Medicine, Chinese Traditional/methods* ; Moxibustion/methods* ; Oxygen Saturation ; Prone Position ; Respiration, Artificial ; Treatment Outcome

OBJECTIVE: To investigate the effect of lateral prone position ventilation in patients with acute respiratory distress syndrome (ARDS). METHODS: A prospective control study was conducted. A total of 75 patients with moderate to severe ARDS admitted to the department of critical care medicine of Jingxian Hospital in Anhui province from January 2020 to December 2022 were selected as the research objects. According to the envelope method, the patients were divided into the lateral prone position ventilation group (38 cases) and the traditional prone position ventilation (PPV) group (37 cases), using lateral prone position ventilation and traditional PPV, respectively. The mechanical ventilation parameters were set according to the ARDS treatment guidelines and lung protective ventilation requirements in both groups, and the time of prone position for the first 3 times was not less than 16 hours per day. General data of patients were recorded, including heart rate (HR), mean arterial pressure (MAP), airway resistance and lung static compliance (Cst) before prone position (T0), 1 hour (T1), 4 hours (T2), 8 hours (T3), and before the end of prone position (T4), oxygenation index (PaO₂/FiO₂) before the first prone position (t0) and 12 hours (t1), 24 hours (t2), 48 hours (t3), and 72 hours (t4) after the intensive care unit (ICU) admission, as well as the incidence of pressure injury (PI) and vomiting, tracheal intubation time, and mechanical ventilation time. Repeated measures analysis of variance was used to compare the effects of different prone positions on patients before and after the prone position. RESULTS: There were no significant differences in age, gender, body mass index (BMI), acute physiology and chronic health evaluation II (APACHE II), underlying diseases, HR, MAP, pH value, PaO₂/FiO₂, blood lactic acid (Lac), arterial blood pressure of carbon dioxide (PaCO₂) and other general information between the two groups. The HR (intergroup effect: F = 0.845, P = 0.361; time effect: F = 1.373, P = 0.247; interaction: F = 0.245, P = 0.894), MAP (intergroup effect: F = 1.519, P = 0.222; time effect: F = 0.169, P = 0.954; interaction: F = 0.449, P = 0.773) and airway resistance (intergroup effect: F = 0.252, P = 0.617; time effect: F = 0.578, P = 0.679; interaction: F = 1.467, P = 0.212) of T0-T4 between two groups showed no significant difference. The Cst of T0-T4 between the two groups showed no significant difference in the intergroup effect (F = 0.311, P = 0.579) and the interaction (F = 0.364, P = 0.834), while the difference in the time effect was statistically significant (F = 120.546, P < 0.001). The PaO₂/FiO₂ of t0-t4 between the two groups showed no significant difference in the intergroup effect (F = 0.104, P = 0.748) and the interaction (F = 0.147, P = 0.964), while the difference in the time effect was statistically significant (F = 17.638, P < 0.001). The group factors and time factors were tested separately, and there were no significant differences in the HR, MAP, airway resistance, Cst, PaO₂/FiO₂ between the two groups at different time points (all P > 0.05). The Cst at T1-T4 and PaO₂/FiO₂ at t1-t4 in the two groups were significantly higher than those at T0/t0 (all P < 0.05). There were no significant differences in the tracheal intubation time [days: 6.75 (5.78, 8.33) vs. 7.00 (6.30, 8.45)] and mechanical ventilation time [days: 8.30 (6.70, 9.20) vs. 7.40 (6.80, 8.75)] between the lateral prone position ventilation group and the traditional PPV group (both P > 0.05). However, the incidences of PI [7.9% (3/38) vs. 27.0% (10/37)] and vomiting [10.5% (4/38) vs. 29.7% (11/37)] in the lateral prone position ventilation group were significantly lower than those in the traditional PPV group (both P < 0.05). CONCLUSIONS Both lateral prone position ventilation and traditional PPV can improve Cst and oxygenation in patients with moderate to severe ARDS. The two types of prone position have little influence on HR, MAP and airway resistance of patients, and there is no difference in the influence on tracheal intubation time and mechanical ventilation time of patients. However, the lateral prone position ventilation mode can reduce the incidence of PI and vomiting, and is worthy of clinical promotion and application.
Humans ; Respiration, Artificial ; Prone Position ; Prospective Studies ; Lung ; Respiratory Distress Syndrome/therapy* ; Respiration ; Vomiting

OBJECTIVE: To systematically review safety and tolerance of enteral nutrition (EN) in a prone position, as well as the risks of increased gastric residual volume (GRV), vomiting, aspiration, and ventilator-associated pneumonia, and determine the ways to improve EN tolerance in patients with acute respiratory distress syndrome (ARDS). METHODS: Databases including PubMed, Embase and Wanfang Medical data of the English and Chinese literatures were retrieved up from January 1979 to January 2022 to collet the randomized controlled trial (RCT), non-RCT, and observational studies, concerning safety and tolerance of EN in a prone position with ARDS. All trials must have a minimum of two patient groups, one of which must be prone to ARDS and receive EN. Data searching extracting and quality evaluation were assessed by two reviewers independently. RevMan 5.4 software was used for analysis. RESULTS: A total of 9 studies were included, including 2 RCTs, 2 non-RCTs, 4 prospective observational studies, and 1 retrospective observational study. The starting and increasing rate of EN were typically well tolerated in the prone position compared to the supine position in patients with ARDS, there was no significant increase in GRV (mL: 95 vs. 110), and the incidence of vomiting was not noticeably higher (0%-35% vs. 33%-57%). The incidence of ventilator-associated pneumonia with EN was not significantly higher in the prone position than in the supine position in patients with ARDS (6%-35% vs. 15%-24%). Aspiration occurred at a similar rate in patients in the nasogastric tube and post-pyloric feeding groups with EN in patients with ARDS in the prone position (22% vs. 20%). EN tolerability with nasogastric and nasojejunal tubes was similar in prone positions, with no significant difference in EN intolerance incidences (15% vs. 22%). Head elevation (30 degree angle-45 degree angle) improved EN tolerance in the prone position in patients with ARDS, thereby increasing the early EN dose [odds ratio (OR) = 0.48, 95% confidence interval (95%CI) was 0.22-1.08, P = 0.08]. Additionally, prophylactic application of gastrointestinal motility drugs, such as erythromycin, at the start of EN in a prone position significantly improved patients' EN tolerance (OR = 1.14, 95%CI was 0.63-2.05, P = 0.67). CONCLUSIONS The use of gastric tube for EN in prone position and similar feeding speed to the supine position in patients with ARDS is safe and well tolerated. The initiation and dosing of EN should not be delayed in the prone position. EN tolerance may be increased by elevating the head of the bed during enteral feeding in a prone position, and gastrointestinal motility medications should be promptly administered with EN initiation in patients with ARDS.
Humans ; Pneumonia, Ventilator-Associated/etiology* ; Enteral Nutrition ; Prone Position ; Respiration, Artificial/adverse effects* ; Respiratory Distress Syndrome/etiology* ; Randomized Controlled Trials as Topic ; Observational Studies as Topic

Humans ; COVID-19 ; Prone Position ; SARS-CoV-2 ; Patient Positioning

The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
Humans ; Consensus ; Prone Position ; Wakefulness ; China ; Dyspnea

Prone position ventilation (PPV) is attracting more and more attention as a part of mechanical ventilation treatment, and relevant consensus and guidelines have been formulated. Prone position therapy (PPT) is widely used in the clinical diagnosis and treatment of burns. Compared with traditional PPV, burn PPT is significantly different in indications, process details, precautions, etc. Therefore, the Burn and Trauma Branch of Chinese Geriatric Society and Critical Care Group of Chinese Burn Association collected the evidence,led the formulation of National expert consensus on prone position therapy in adult burn patients (2022 version), and formulated recommendations on action mechanism, indications, use process of PPT for clinical guidance.
Adult ; Aged ; Burns/therapy* ; Consensus ; Fluid Therapy ; Humans ; Prone Position ; Respiration, Artificial

Objective: The World Health Organization (WHO) recommends prone positioning for mechanically ventilated COVID-19 patients with Acute Respiratory Distress Syndrome (ARDS) to improve oxygenation. Subsequently, researchers facilitated the position to non-intubated COVID-19 patients as early management which showed significant improvement but with discerned limitations. Tripod position is explored as an alternative exhibiting promising results. This present study describes a case series of four COVID-19 patients with moderate to severe ARDS who demonstrated considerable breakthrough. Methods: Four COVID-19 cases of moderate to severe ARDS were instructed to do tripod positioning as long as they can tolerate while under close supervision. Results: An hour after assuming tripod position, all four patients presented a decrease in respiratory rate, increase in peripheral oxygen saturation, and increase in partial oxygen saturation in arterial blood gas. The assumed position was maintained by four patients without discomfort and was maintained with a mean of 12 - 20 hours per day. Conclusions Our findings confirmed that tripod position is advantageous to non-intubated COVID-19 patients with moderate to severe ARDS and may delay or prevent invasive mechanical ventilation. The position also manifested tolerance to extended duration which permitted time for the medical team to focus on managing their disease in its entirety. Nevertheless, certain aspects such as contraindication, side effects, and other adverse events that may occur have yet to be sufficiently clarified and investigated.
Prone Position ; Respiratory Distress Syndrome ; COVID-19