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An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient

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Effect of Prone Position on Oxygenation Parameters of Intubated Patients Due to COVID-19-Related ARDS: Prospective

Reva Balci Akpinar¹, Ümit Karatepe², Sümeyye Bilgili Tekin³

¹Ataturk University, Faculty of Nursing, Department of Nursing Fundamentals, Erzurum, Turkey.

Nursing in Critical Care

|January 7, 2026

Abstract

Background:

Prone positioning (PP) is widely used to improve oxygenation in acute respiratory distress syndrome (ARDS), but evidence in mechanically ventilated COVID-19 ARDS is heterogeneous.

Aim:

To evaluate the effect of 16-h daily PP on oxygenation, ventilation, laboratory and radiological parameters in intubated patients with COVID-19-related ARDS.

Study Design:

In this prospective cohort, 40 intubated patients were followed for 3 days: PP group (n = 20; PaO₂/FiO₂ ≤ 100) and supine position (SP) group (n = 20; PaO₂/FiO₂ ≤ 200). Ventilator settings, oxygenation/ventilation parameters (PaO₂, PaCO₂, HCO₃, lactate, pH and SaO₂), PaO₂/FiO₂ ratio, haematologic/biochemical markers (C-reactive protein (CRP), fibrinogen, D-dimer, ferritin, lymphocyte count, procalcitonin, platelet count and LDH) and daily chest radiographs were recorded.

Results:

Within-group analyses in the PP group showed significant changes over time in PaO₂ (p = 0.024), PaCO₂ (p = 0.035), PaO₂/FiO₂ (p < 0.001), pH (p = 0.004), fibrinogen (F = 7.600; p = 0.002), procalcitonin (F = 3.828; p = 0.043), platelet count (F = 6.486; p = 0.013), and LDH (F = 8.862; p = 0.002) no significant within group changes were observed in the SP group (fibrinogen, p = 0.068; procalcitonin p = 0.093; platelet p = 0.068; LDH p = 0.227). SaO₂ was higher in the PP group than in the SP group at M3 on Day 2: PP: 92.13 ± 5.5 vs. SP: 88.24 ± 6.02%; t = 2.131; mean difference +3.89 (95% CI 0.19 to 7.57; p = 0.040). CRP decreased over time in both groups (PP: p = 0.008; SP: p = 0.001). Radiographically, ground-glass opacities decreased in 70% of PP vs. 25% of SP patients (p = 0.001).

Conclusions:

This study suggests that the prone position may be more effective in improving clinical and oxygenation parameters in intubated COVID-19 patients with severe ARDS.

Relevance To Clinical Practice:

This study provides evidence to guide the management of COVID-19-related ARDS. The findings may support ICU nurses' clinical decisions and improve care protocols for similar patients. Clinically, maintaining ARDS patients in the prone position (PP) aids recovery. In intensive care units, experienced nurses should ensure correct patient positioning and provide continuous monitoring.

Keywords:

COVID‐19 acute respiratory distress syndrome oxygenation prone position supine position

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