Prone Positioning for Pregnant Women With Hypoxemia Due to Coronavirus Disease 2019 (COVID-19)
Prone Positioning for Pregnant Women With Hypoxemia Due to Coronavirus Disease 2019 (COVID-19)
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DOI：
10.1097/aog.0000000000004012
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发表时间：
2020-08-01
影响因子：
7.2
通讯作者：
Nates, Joseph L.
中科院分区：
文献类型：
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作者：
Tolcher, Mary Catherine;McKinney, Jennifer R.;Nates, Joseph L.
2019 年冠状病毒病 (COVID-19) 大流行促使俯卧位治疗难治性低氧血症的广泛应用。临床试验已证明早期俯卧位对急性呼吸窘迫综合征 (ARDS) 具有有益效果，包括降低死亡率。然而，孕妇被排除在这些试验之外。为了满足以低氧血症为主的广泛病毒综合症对低成本、低伤害干预措施的需求，我们开发了一种用于插管和非插管孕妇俯卧位的算法。该算法可能适用于孕妇中各种严重的低氧血症。严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 病毒是导致 COVID-19 临床表现的原因。该综合征可表现为严重肺炎并发低氧血症和ARDS。鉴于当前全球 COVID-19 大流行以及大量 ARDS 病例，人们重新对使用俯卧位来改善中度或重度低氧血症的氧合产生了兴趣。只要考虑到怀孕的生理变化和风险，患有严重呼吸窘迫的孕妇就可以从俯卧位中受益。
The coronavirus disease 2019 (COVID-19) pandemic has prompted expanded use of prone positioning for refractory hypoxemia. Clinical trials have demonstrated beneficial effects of early prone positioning for acute respiratory distress syndrome (ARDS), including decreased mortality. However, pregnant women were excluded from these trials. To address the need for low-cost, low-harm interventions in the face of a widespread viral syndrome wherein hypoxemia predominates, we developed an algorithm for prone positioning of both intubated and nonintubated pregnant women. This algorithm may be appropriate for a wide spectrum of hypoxemia severity among pregnant women. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is responsible for the clinical manifestations of COVID-19. This syndrome can manifest as severe pneumonia complicated by hypoxemia and ARDS. Given the current global COVID-19 pandemic, with a large number of ARDS cases, there is renewed interest in the use of prone positioning to improve oxygenation in moderate or severe hypoxemia. Among the populations who can benefit from prone positioning are pregnant women experiencing severe respiratory distress, as long as the physiologic changes and risks of pregnancy are taken into account.