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Short-Term Outcomes of the First-Session Prone Position in Patients With Severe Coronavirus Disease 2019: A

Makoto Onji1, Shinji Kakizoe1, Asuka Nakai1

  • 1Department of Rehabilitation, Kitakyushu Municipal Medical Center, Kitakyushu, JPN.

Cureus
|March 30, 2023
PubMed

Insights

Patients with severe COVID-19 who showed improved oxygen levels after initial prone positioning had better outcomes. This includes shorter ventilator duration and higher daily living activity scores at discharge.

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Infectious Diseases

Background:

  • Prone positioning is recommended for severe COVID-19 patients on mechanical ventilation.
  • The short-term efficacy of the initial prone positioning session is not well-established.
  • Understanding predictors of positive response is crucial for optimizing patient management.

Purpose of the Study:

  • To evaluate the impact of the initial prone positioning session on patient outcomes.
  • To assess the relationship between the change in the partial pressure of oxygen/fraction of inspired oxygen (P/F) ratio and short-term outcomes.
  • To determine the effect on activities of daily living (ADL) and discharge status.

Main Methods:

  • Retrospective chart review of 22 severe COVID-19 patients requiring mechanical ventilation.
  • Patients categorized as responders (>16 mmHg P/F ratio improvement) and non-responders (<16 mmHg).
  • Analysis of ventilator duration, Barthel Index at discharge, and discharge proportion.

Main Results:

  • Responders demonstrated significantly shorter ventilator duration compared to non-responders.
  • Responders achieved higher Barthel Index scores, indicating better functional status at discharge.
  • A higher proportion of responders were discharged from the hospital.

Conclusions:

  • Initial prone positioning response, indicated by P/F ratio improvement, predicts better short-term outcomes in severe COVID-19.
  • Improved P/F ratio post-prone positioning correlates with enhanced activities of daily living and discharge success.
  • This study highlights the prognostic value of early response to prone ventilation in critically ill COVID-19 patients.

Keywords:
activities of daily livingcoronavirus disease 2019covid-19mechanical ventilationprone positionsevere coronavirus disease 2019short-term outcomes

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