COVID-19中等症患者へのパンフレット指導による覚醒下腹臥位療法の実現可能性
【目的】覚醒下腹臥位療法（Awake Prone Positioning：以下，APP）パンフレットで指導したCOVID-19中等症患者自身でのAPPの実現可能性を調査した．【方法】COVID-19中等症で入院した12例を対象とした．APPのパンフレットを用いて指導し，初回は30分間実施して安全性を確認し，その後は患者自身での実施を指導した．APPの実施率，実施時間の調査と初回APP実施前後における呼吸パラメーターを比較した．【結果】実施率は83％［64－100］，連続時間は60分［30－110］，1日あたり実施時間は220分［146－347］であった．重大な有害事象は認めなかった．初回APP...
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| Published in | 日本呼吸ケア・リハビリテーション学会誌 Vol. 31; no. 3; pp. 328 - 333 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本呼吸ケア・リハビリテーション学会
31.08.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1881-7319 2189-4760 |
| DOI | 10.15032/jsrcr.21-42 |
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| Abstract | 【目的】覚醒下腹臥位療法（Awake Prone Positioning：以下，APP）パンフレットで指導したCOVID-19中等症患者自身でのAPPの実現可能性を調査した．【方法】COVID-19中等症で入院した12例を対象とした．APPのパンフレットを用いて指導し，初回は30分間実施して安全性を確認し，その後は患者自身での実施を指導した．APPの実施率，実施時間の調査と初回APP実施前後における呼吸パラメーターを比較した．【結果】実施率は83％［64－100］，連続時間は60分［30－110］，1日あたり実施時間は220分［146－347］であった．重大な有害事象は認めなかった．初回APPの実施前後でSpO2と呼吸数が有意に改善した．【結論】本研究の方法は，簡便かつ安全で，APPの高い実施率を示し，医療従事者の感染リスクの減少，負担軽減に寄与する可能性が示唆された． |
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| AbstractList | 【目的】覚醒下腹臥位療法（Awake Prone Positioning：以下，APP）パンフレットで指導したCOVID-19中等症患者自身でのAPPの実現可能性を調査した．【方法】COVID-19中等症で入院した12例を対象とした．APPのパンフレットを用いて指導し，初回は30分間実施して安全性を確認し，その後は患者自身での実施を指導した．APPの実施率，実施時間の調査と初回APP実施前後における呼吸パラメーターを比較した．【結果】実施率は83％［64－100］，連続時間は60分［30－110］，1日あたり実施時間は220分［146－347］であった．重大な有害事象は認めなかった．初回APPの実施前後でSpO2と呼吸数が有意に改善した．【結論】本研究の方法は，簡便かつ安全で，APPの高い実施率を示し，医療従事者の感染リスクの減少，負担軽減に寄与する可能性が示唆された． |
| Author | 髙野, 智嗣 木村, よう子 山内, 康太 田中, 翔太 鈴木, 裕也 熊谷, 謙一 後藤, 圭 香西, 哲也 池永, 千寿子 山下, 真希 |
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| References | 13) Shannon C, Qais Z, Shannon L, et al.: Proning during covid-19: challenges and solutions. Heart Lung 49: 686-687, 2020. 18) Xu Q, Wang T, Qin X, et al.: Early awake prone position combined with high-flow nasal oxygen therapy in severe COVID-19: a case series. Crit Care 24: 250, 2020 4) 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. Lancet Respir Med 8: 765-774, 2020. 9) Li J, Luo J, Pavlov I, et al.: Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Lancet Respir Med 10: 573-583, 2022. 7) Alhazzani W, Møller MH, Arabi YM, et al.: Surviving Sepsis Campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). Intensive Care Med 46: 854-887, 2020. 14) Neuner-Jehle S, Schmid M, Grüninger U: The “Health Coaching” programme: a new patient-centred and visually supported approach for health behaviour change in primary care. BMC Fam Pract 14: 100, 2013. 16) Nasa P, Azoulay E, Khanna AK, et al.: Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method. Crit Care 25: 106, 2021. 3) Munshi L, Del Sorbo L, Adhikari NKJ, et al.: Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Ann Am Thorac Soc 14 (Supplement 4): S280-S288, 2017. 11) Kevin S, Jason W, Parhar K, et al.: Tolerability and safety of awake prone positioning COVID-19 patients with severe hypoxemic respiratory failure. Can J Anaesth 68: 64-70, 2021. 20) Cruces P, Retamal J, Hurtado DE, et al.: A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection. Crit Care 24: 494, 2020. 15) Prud’homme E, Trigui Y, Elharrar X, et al.: Effect of prone positioning on the respiratory support of nonintubated patients with COVID-19 and acute hypoxemic respiratory failure: a retrospective matching cohort study. Chest 160: 85-88, 2021. 19) Ng Z, Tay WC, Ho CHB: Awake prone positioning for non-intubated oxygen dependent COVID-19 pneumonia patients. Eur Respir J 56: 2001198, 2020 2) Wu C, Chen X, Cai Y, 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 180: 934-943, 2020. 8) Stephan E, Jie L, Estrada I, et al.: Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med 9: 1387-1395, 2021. 1) Wang D, Hu B, Hu C, et al.: Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 323: 1061-1069, 2020. 5) Scaravilli V, Grasselli G, Castagna L, et al.: Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: a retrospective study. J Crit Care 30: 1390-1394, 2015. 6) Guérin C, Albert RK, Beitler J, et al.: Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med 46: 2385-2396, 2020. 17) Ponnapa Reddy M, Subramaniam A, Afroz A, et al.: Prone positioning of nonintubated patients with coronavirus disease 2019-A systematic review and meta-analysis. Crit Care Med 49: e1001-e1014, 2021. 10) Telias I, Katira BH, Brochard L: Is the prone position helpful during spontaneous breathing in patients with COVID-19? JAMA 323: 2265-2267, 2020. 12) Jayakumar D, Ramachandran Dnb P, Rabindrarajan Dnb E, et al.: Standard care versus awake prone position in adult nonintubated patients with acute hypoxemic respiratory failure secondary to COVID-19 infection—a multicenter feasibility randomized controlled trial. J Intensive Care Med 36: 918-924, 2021. |
| References_xml | – reference: 11) Kevin S, Jason W, Parhar K, et al.: Tolerability and safety of awake prone positioning COVID-19 patients with severe hypoxemic respiratory failure. Can J Anaesth 68: 64-70, 2021. – reference: 20) Cruces P, Retamal J, Hurtado DE, et al.: A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection. Crit Care 24: 494, 2020. – reference: 12) Jayakumar D, Ramachandran Dnb P, Rabindrarajan Dnb E, et al.: Standard care versus awake prone position in adult nonintubated patients with acute hypoxemic respiratory failure secondary to COVID-19 infection—a multicenter feasibility randomized controlled trial. J Intensive Care Med 36: 918-924, 2021. – reference: 13) Shannon C, Qais Z, Shannon L, et al.: Proning during covid-19: challenges and solutions. Heart Lung 49: 686-687, 2020. – reference: 14) Neuner-Jehle S, Schmid M, Grüninger U: The “Health Coaching” programme: a new patient-centred and visually supported approach for health behaviour change in primary care. BMC Fam Pract 14: 100, 2013. – reference: 18) Xu Q, Wang T, Qin X, et al.: Early awake prone position combined with high-flow nasal oxygen therapy in severe COVID-19: a case series. Crit Care 24: 250, 2020 – reference: 7) Alhazzani W, Møller MH, Arabi YM, et al.: Surviving Sepsis Campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). Intensive Care Med 46: 854-887, 2020. – reference: 5) Scaravilli V, Grasselli G, Castagna L, et al.: Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: a retrospective study. J Crit Care 30: 1390-1394, 2015. – reference: 17) Ponnapa Reddy M, Subramaniam A, Afroz A, et al.: Prone positioning of nonintubated patients with coronavirus disease 2019-A systematic review and meta-analysis. Crit Care Med 49: e1001-e1014, 2021. – reference: 19) Ng Z, Tay WC, Ho CHB: Awake prone positioning for non-intubated oxygen dependent COVID-19 pneumonia patients. Eur Respir J 56: 2001198, 2020 – reference: 2) Wu C, Chen X, Cai Y, 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 180: 934-943, 2020. – reference: 3) Munshi L, Del Sorbo L, Adhikari NKJ, et al.: Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Ann Am Thorac Soc 14 (Supplement 4): S280-S288, 2017. – reference: 8) Stephan E, Jie L, Estrada I, et al.: Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med 9: 1387-1395, 2021. – reference: 1) Wang D, Hu B, Hu C, et al.: Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 323: 1061-1069, 2020. – reference: 4) 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. Lancet Respir Med 8: 765-774, 2020. – reference: 9) Li J, Luo J, Pavlov I, et al.: Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Lancet Respir Med 10: 573-583, 2022. – reference: 10) Telias I, Katira BH, Brochard L: Is the prone position helpful during spontaneous breathing in patients with COVID-19? JAMA 323: 2265-2267, 2020. – reference: 15) Prud’homme E, Trigui Y, Elharrar X, et al.: Effect of prone positioning on the respiratory support of nonintubated patients with COVID-19 and acute hypoxemic respiratory failure: a retrospective matching cohort study. Chest 160: 85-88, 2021. – reference: 6) Guérin C, Albert RK, Beitler J, et al.: Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med 46: 2385-2396, 2020. – reference: 16) Nasa P, Azoulay E, Khanna AK, et al.: Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method. Crit Care 25: 106, 2021. |
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| SubjectTerms | コロナウイルス感染症 実現可能性 腹臥位療法 覚醒下腹臥位療法 |
| Title | COVID-19中等症患者へのパンフレット指導による覚醒下腹臥位療法の実現可能性 |
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