Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19

Abstract

Hypoxemia of the acute respiratory distress syndrome can be reduced by turning patients prone. Prone positioning (PP) is labor intensive, risks unplanned tracheal extubation, and can result in facial tissue injury. We retrospectively examined prolonged, repeated, and early versus later PP for 20 patients with COVID-19 respiratory failure. Blood gases and ventilator settings were collected before PP, at 1, 7, 12, 24, 32, and 39 h after PP, and 7 h after completion of PP. Analysis of variance was used for comparisons with baseline values at supine positions before turning prone. PP for >39 h maintained PaO2/FiO2 (P/F) ratios when turned supine; the P/F decrease at 7 h was not significant from the initial values when turned supine. Patients turned prone a second time, when again turned supine at 7 h, had significant decreased P/F. When PP started for an initial P/F ≤ 150 versus P/F > 150, the P/F increased throughout the PP and upon return to supine. Our results show that a single turn prone for >39 h is efficacious and saves the burden of multiple prone turns, and there is no significant advantage to initiating PP when P/F > 150 compared to P/F ≤ 150.

Associated Factors of High Sedative Requirements within Patients with Moderate to Severe COVID-19 ARDS

“…Prone positioning was performed within the early available therapy recommendations regarding CARDS therapy [22,23]. The practice of regular prone positioning, which has since been incorporated into the guidelines, was maintained due to the emerging evidence during the course of the pandemic [31,32].…”

Tidal volume significantly affects oxygenation in healthy pigs during high-frequency oscillatory ventilation compared to conventional ventilation

“…Clinicians are studying new techniques and approaches. Effect of extracorporeal membrane oxygenation [ 28 , 29 ], different levels of PEEP [ 30 ], prone positioning [ 31 , 32 ], respiratory system impedance analysis [ 33 ], and different times of weaning [ 34 ] has been studied. For the use of HFOV in the treatment of ARDS, there is a need to understand the place of HFOV in the spectrum of diagnostic and therapeutic techniques for severe ARDS care and to define the optimal HFOV strategy [ 35 ].…”

Special Issue “Pulmonary and Critical Care Practice in the Pandemic of COVID-19”

“…These findings were confirmed in different randomized trials, including the RECOVERY and REMAP-CAP trials [ 10 , 11 ]. Other aspects of COVID-19 ARDS management were also addressed in this Special Issue [ 12 , 13 ]. In ARDS, the prone position (PP) is commonly used to increase oxygenation, with the overall goal of minimizing ventilator-induced lung damage.…”

“…The PP allows a better distribution of the transpulmonary pressure, relieves the lungs behind the heart, and improves lymphatic drainage. Interestingly, Parker et al [ 12 ] showed that a single PP duration of >39 h was safe and effective, sparing the burden of multiple prone position sessions. Furthermore, there was no significant advantage in initiating PP when the PaO 2 /FiO 2 ratio was >150 mmHg [ 12 ].…”

“…Interestingly, Parker et al [ 12 ] showed that a single PP duration of >39 h was safe and effective, sparing the burden of multiple prone position sessions. Furthermore, there was no significant advantage in initiating PP when the PaO 2 /FiO 2 ratio was >150 mmHg [ 12 ]. The effects of tracheostomy techniques and timing on the outcomes of COVID-19 patients were also investigated.…”