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Updated: Jun 10, 2025

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Complications associated with prone positioning in mechanically ventilated COVID-19 patients: A multicentre,

Thomas C Rollinson1, Luke A McDonald2, Joleen Rose2

  • 1Department of Intensive Care, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia.

Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses
|October 15, 2024
PubMed

Insights

Prone positioning for COVID-19 acute respiratory distress syndrome (ARDS) can cause complications. Pressure injuries and device dislodgement were most common, with male sex and more prone positioning episodes increasing pressure injury risk.

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Infectious Diseases

Background:

  • Prone positioning is a key intervention for improving gas exchange in mechanically ventilated patients with COVID-19-related ARDS.
  • While beneficial, prone positioning is associated with potential complications that require monitoring.

Purpose of the Study:

  • To determine the prevalence of specific complications linked to prone positioning in mechanically ventilated COVID-19 ARDS patients.
  • To identify factors associated with the occurrence of these complications.

Main Methods:

  • A multicentre, retrospective observational study was conducted.
  • Data from 220 mechanically ventilated COVID-19 ARDS patients across seven intensive care units were analyzed.
  • Complications, baseline characteristics, and patient outcomes related to 553 prone positioning episodes were collected.

Main Results:

  • Over half of patients (58%) experienced at least one complication during prone positioning.
  • Pressure injury was the most frequent complication (42%), with male sex and increased prone positioning episodes as significant risk factors.
  • Device dislodgement occurred in 13% of patients; no nerve or retinal injuries were reported.

Conclusions:

  • Pressure injuries and line dislodgement are the most common complications of prone positioning in COVID-19 ARDS.
  • Risk stratification for pressure injuries should consider patient sex and the duration/frequency of prone positioning.
Abstract

Keywords:
ARDSCOVID-19ComplicationsPressure InjuriesProne positioning

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