Comparing Prone Positioning Use in COVID-19 Versus Historic Acute Respiratory Distress Syndrome

Area of Science:

• Critical Care Medicine
• Pulmonology
• Infectious Diseases

Background:

• Prone positioning is a key intervention for acute respiratory distress syndrome (ARDS).
• The impact of the COVID-19 pandemic on the utilization of prone positioning for ARDS management remains unclear.
• Understanding practice variations is crucial for optimizing patient care.

Purpose of the Study:

• To compare the utilization of prone positioning in patients with COVID-19 ARDS versus ARDS from non-COVID-19 causes prior to the pandemic.
• To identify differences in the timing, duration, and frequency of prone positioning between the two patient cohorts.

Main Methods:

• A multicenter retrospective cohort study was conducted.
• Mechanically ventilated patients with moderate-to-severe ARDS (COVID-19 and non-COVID-19) were analyzed across 19 ICUs.
• Key outcomes included the initiation of prolonged prone positioning within 48 hours, time to initiation, and duration of prone sessions.

Main Results:

• Prone positioning was initiated within 48 hours in 58.4% of COVID-19 ARDS patients versus 8.9% of historic ARDS patients, representing a 49.4% absolute increase.
• Initiation of prone positioning was significantly earlier (12.9 vs 30.6 hours) and sessions were longer (43.0 vs 28.0 hours) in the COVID-19 cohort.
• Prone positioning frequency increased rapidly and was sustained throughout the pandemic, with similar increases across academic and community settings but larger increases in medical ICUs.

Conclusions:

• COVID-19 ARDS management saw substantially greater use of prone positioning compared to pre-pandemic ARDS.
• The observed rapid adoption of prone positioning, with earlier initiation and longer durations, highlights a successful implementation of evidence-based practice.
• This practice shift in critical care during the pandemic can serve as a valuable model for future clinical interventions.