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SYSTEMATIC REVIEW   Open accessopen access

European Journal of Physical and Rehabilitation Medicine 2023 February;59(1):111-21

DOI: 10.23736/S1973-9087.22.07529-3

Copyright © 2022 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

language: English

Long-term complications of prone position ventilation with relevance for acute and postacute rehabilitation: a systematic review of the literature

Nancy ELMER 1, 2 , Anett REIßHAUER 1, 2, Katharina BREHM 1, 2, Clarissa VOCKEROTH 1, 2, Max E. LIEBL 1, 2

1 Department of Physical Medicine, Charité - Universitätsmedizin Berlin, Free University of Berlin, Berlin, Germany; 2 Humboldt University of Berlin, Berlin, Germany

INTRODUCTION: Prone positioning ventilation (PPV) is an effective treatment for patients with moderate to severe acute respiratory distress syndrome (ARDS). Despite the benefits of PPV, different kinds of short and long-term consequences have been noted. This review summarizes long-term complications of PPV that impact treatment strategies and outcomes in acute and postacute rehabilitation.
EVIDENCE ACQUISITION: PubMed/Medline, Cochrane Library, Cochrane COVID-19 Study Register databases and the Google Scholar search engine were systematically searched for studies investigating long-term complications of PPV. The final search date for all sources/databases was January 31, 2022. For our methodological appraisal, we conducted a systematic review of articles without any restrictions on types of articles or publication dates. Only articles published in English and available as full texts were eligible for inclusion. After the screening process, data of interest were extracted from eligible sources: PPV sequelae and conclusions (i.e. possible effects on the course of rehabilitation and therapy strategies).
EVIDENCE SYNTHESIS: A total of 59 studies are included in this review. Long-term consequences are mainly pressure ulcers and nerve lesions that exist after discharge from the Intensive Care Unit (ICU). Publications rarely recommend treatment strategies for long-term complications after PPV. Due to the quality of the included studies, no robust conclusions as to effective strategies can be drawn.
CONCLUSIONS: Further high-quality research is required, considering the different long-term complications after PPV and their impact on rehabilitation in order to draw conclusions about viable physical therapies. Crucially, however, prone positioning (PP) sequelae pose new challenges to physicians and therapists in acute and postacute rehabilitation medicine as well as follow-up care.

KEY WORDS: COVID-19; Respiratory distress syndrome; Critical illness; Prone position; Follow-up studies

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