Early Prone versus Supine Positioning in Moderate to Severe Coronavirus Disease 2019 Patients with Acute Respiratory Distress Syndrome

Abstract

Objectives: This study sought to determine whether early prone positioning of patients with moderate to severe COVID-19-related acute respiratory distress syndrome (ARDS) lowers the mortality rate. Methods: We conducted a retrospective study using data from intensive care units of two tertiary centers in Oman. Adult patients with moderate to severe COVID-19-related ARDS with a PaO2/FiO2 ratio < 150 on FiO2 of 60% or more and a positive end-expiratory pressure of at least 8 cm H2O who were admitted between 1 May 2020 and 31 October 2020 were selected as participants. All patients were intubated and subjected to mechanical ventilation within 48 hours of admission and placed in either prone or supine position. Mortality was measured and compared between the patients from the two groups. Results: A total of 235 patients were included (120 in the prone group and 115 in the supine group). There were no significant differences in mortality (48.3% vs. 47.8%; p =0.938) and discharge rates (50.8% vs. 51.3%; p =0.942) between the prone and supine groups, respectively. Conclusions: Early prone positioning of patients with COVID-19-related ARDS does not result in a significant reduction in mortality.

Prone Vs. Supine Position Ventilation in Intubated COVID-19 Patients: A Systematic Review and Meta-Analysis

“…After inclusion and exclusion criteria were applied, seven retrospective cohort studies that encompassed 5216 patients with COVID-19 were included in the analysis [20][21][22][23][24][25][26].…”

“…Hospital mortality: The combined data from six studies that included 4665 patients did not reveal a significant difference in hospital mortality between the prone and supine groups (OR, 0.95; 95% CI, 0.66-1.37; P = 0.78), indicating no significant association between prone positioning and hospital mortality for patients with COVID-19. However, the studies had significant heterogeneity, with an I 2 of 89% (Figure 3) [20][21][22][23]25,26]. Overall mortality: Data combined from all seven studies, including 5216 patients, revealed no difference in overall mortality between the prone and supine groups (OR, 1.08; 95% CI, 0.72-1.64; P = 0.71).…”

“…Mechanical ventilation days: Data combined from two studies, including 1791 patients, revealed no difference in mechanical ventilation days between the prone and supine groups (MD, 3.28; 95 %, 4.02-10.58; P = 0.38). The studies had significant heterogeneity (I 2 = 98%) (Figure 5) [21,26]. ICU length of stay: Data combined from three studies, including 2026 patients, revealed no difference in ICU length of stay between the prone and supine groups (MD, 2.28; 95 %, 1.17-5.74; P = 0.20).…”

“…ICU length of stay: Data combined from three studies, including 2026 patients, revealed no difference in ICU length of stay between the prone and supine groups (MD, 2.28; 95 %, 1.17-5.74; P = 0.20). The studies had significant heterogeneity (I 2 = 89%) (Figure 6) [21,25,26]. Hospital length of stay: Data combined from four studies, including 2287 patients, revealed a prolonged hospital length of stay in the prone group (MD, 6.0; 95 %, 3.15-8.97; P < 0.0001).…”

“…heterogeneity, CI: confidence interval, M-H: Mantel-Haenszel method Source: references[20][21][22][23]25,26] …”