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Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes

Alexander Jackson1, Florence Neyroud2, Josephine Barnsley2

  • 1NIHR Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton SO16 6YD, UK.

Journal of Clinical Medicine
|July 14, 2023
PubMed

Insights

Prone positioning improved oxygenation in mechanically ventilated COVID-19 patients regardless of timing. Early, intermediate, and late initiation of prone positioning all showed favorable oxygenation responses.

Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology
  • Infectious Diseases

Background:

  • The COVID-19 pandemic necessitated widespread use of prone positioning to improve oxygenation in critically ill patients.
  • Limited data exists on how the timing of prone positioning initiation affects outcomes in mechanically ventilated COVID-19 patients.

Purpose of the Study:

  • To analyze the impact of initiating prone positioning at different time points on oxygenation in mechanically ventilated COVID-19 patients.
  • To evaluate the effectiveness of early, intermediate, and late prone positioning strategies.

Main Methods:

  • Retrospective analysis of 931 prone positioning episodes in 144 mechanically ventilated COVID-19 patients.
  • Categorization of proning cycles into early (within 7 days), intermediate (7-14 days), and late (>14 days) from intubation.
  • Measurement of the change in the PaO2/FiO2 ratio (ΔPF) as an indicator of oxygenation response.

Main Results:

  • A significant improvement in oxygenation (mean ΔPF of 16.6 mmHg) was observed across all proning episodes (p < 0.001).
  • No significant difference in oxygenation response was found between early (18.5 mmHg), intermediate (13.2 mmHg), and late (14.8 mmHg) prone positioning cycles (p = 0.2).
  • Favorable oxygenation responses were noted even when prone positioning was initiated more than 14 days after intubation.

Conclusions:

  • Prone positioning demonstrates a beneficial effect on oxygenation in mechanically ventilated COVID-19 patients at all initiation time points.
  • The timing of prone positioning initiation does not significantly alter the oxygenation response.
  • Further research is required to determine if these findings translate to improved survival advantages.

Keywords:
COVID-19critical caremechanical ventilationprone

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