Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19

Area of Science:

• Critical Care Medicine
• Pulmonology
• Respiratory Therapy

Background:

• Acute Respiratory Distress Syndrome (ARDS) often causes hypoxemia.
• Prone positioning (PP) is a recognized intervention for ARDS, but it is resource-intensive and carries risks.
• Optimizing PP protocols for COVID-19 patients is crucial.

Purpose of the Study:

• To evaluate the efficacy of prolonged, repeated, and early versus later prone positioning (PP) in COVID-19 patients with respiratory failure.
• To determine the optimal duration and timing for PP to maintain oxygenation.

Main Methods:

• Retrospective analysis of 20 COVID-19 patients with respiratory failure.
• Data collection included blood gases and ventilator settings at various time points before, during, and after PP.
• Statistical comparison using analysis of variance (ANOVA) against baseline supine values.

Main Results:

• Prolonged PP (>39 hours) maintained oxygenation (PaO2/FiO2 ratios) upon return to the supine position.
• Repeated PP sessions resulted in a significant decrease in oxygenation when patients were returned to the supine position.
• Initiating PP at lower (≤150) versus higher (>150) PaO2/FiO2 ratios showed similar improvements throughout and after PP.

Conclusions:

• A single, prolonged prone positioning session exceeding 39 hours is effective in improving and maintaining oxygenation in COVID-19 patients.
• This approach reduces the labor and risks associated with multiple prone positioning turns.
• There is no clear benefit to initiating prone positioning earlier when oxygenation is already relatively high (PaO2/FiO2 > 150).