Nursing Management of Prone Positioning in Patients With COVID-19

Abstract

Background At the height of the coronavirus disease 2019 (COVID-19) pandemic, Italy had the highest number of deaths in Europe; most occurred in the Lombardy region. Up to 4% of patients with COVID-19 required admission to an intensive care unit because they developed a critical illness (eg, acute respiratory distress syndrome). Numerous patients with acute respiratory distress syndrome who had been admitted to the intensive care unit required rescue therapy like prone positioning. Objectives To describe the respiratory management of and the extensive use of prone positioning in patients with COVID-19 at the intensive care unit hub in Lombardy, Italy. Methods A total of 89 patients (67% male; median age, 59 years [range, 23-80 years]) with confirmed COVID-19 who were admitted between February 23 and March 31, 2020, were enrolled in this quality improvement project. Results Endotracheal intubation was required in 86 patients (97%). Prone positioning was used as rescue therapy in 43 (48%) patients. Significantly more younger patients (age ≤ 59 years) were discharged alive (43 of 48 [90%]) than were older patients (age ≥ 60 years; 26 of 41 [63%]; P < .005). Among the 43 patients treated with prone ventilation, 15 (35% [95% CI, 21%-51%]) died in the intensive care unit, of which 10 (67%; P < .001) were older patients. Conclusions Prone positioning is one strategy available for treating acute respiratory distress syndrome in patients with COVID-19. During this pandemic, prone positioning can be used extensively as rescue therapy, per a specific protocol, in intensive care units.

Complications of prone positioning in patients with COVID-19: A cross-sectional study

“…Considering the critical conditions of patients with COVID-19, at least four healthcare professionals and one experienced team leader were necessary during the maneuver to coordinate each step, as to minimize all possible risks. The prone position maneuver followed a strict protocol, and an available decision-making algorithm was used to guide the healthcare professionals through performing a safe procedure, as already reported by our group elsewhere ( Binda et al, 2021 ). Before the procedure, the gastric content was suctioned to avoid inhalation and enteral nutrition was continued, except during the maneuver ( Martindale et al, 2020 ).…”

“…The extensive use of prone position in a large number of critical patients represented the major challenge for nurses and physicians in intensive care unit (ICU) during the pandemic ( Binda et al, 2021 ). As suggested, using a specific protocol to support ICU staff about prone position-related decisions may limit the occurrence of complications and improve the safety in patients who are not responsive to conventional mechanical ventilation ( Carsetti et al, 2020 ).…”

Effectiveness of prone position in acute respiratory distress syndrome and moderating factors of obesity class and treatment durations for COVID-19 patients: A meta-analysis

“…Several studies showed that the traditional ICU prone position of the patients with COVID-19 ARDS had significant improvements (Abou-Arab, Haye, 2021, Clarke, Geoghegan, 2021, Mittermaier, Pickerodt, 2020, Paternoster, Sartini, 2020, Ziehr, Alladina, 2020). However, traditional prone position in the ICU in patients with critical illness is not without risk because of patient condition (e.g., the need for heavier sedation, hemodynamic instability, device displacement, pressure ulcers) ( Binda et al, 2021 ).…”

Implementation of a Follow-Up Program for Intensive Care Unit Survivors

“…Despite prone positioning has been shown to reduce mortality in ARDS patients [ 43 , 44 ], we must keep in mind that can also be associated with various complications, including pressure sores and accidental injuries [ 45 , 46 , 47 , 48 ]. During the study period, the prone position protocol in our unit involved the use of the “swimmer position”.…”