Prone Versus Supine Ventilation and Mortality Outcome in Intubated COVID-19 Patients, a Revision Letter

Abstract

In the article, it has been mentioned that prone positioning provided a mortality benefit to intubated patients with COVID-19, as opposed to the patients who did not undergo prone positioning. It was reported that of the patients who underwent prone positioning, 77.4% died, as opposed to 83.9% of patients who did not. The authors mentioned some limitations of the study, but we think it needs to be addressed.Several factors affected the outcomes. Firstly patients' demographics were different in both groups. In the supine group, 15.6% of patients were above 80 years old, as opposed to 1.6% in the prone group. Secondly, comorbid conditions were more frequent in the supine group as opposed to the prone group of patients as follows: Congestive heart failure (9% vs 1.6%), chronic kidney disease (12.6% vs 6.5%), and smoking history (6.5% vs 1.6%). Thirdly, critical COVID-19 patients were 67.8% in the supine group as opposed to 46.8% in the prone group. Lastly, the treatment provided differed in both groups, where more patients in the supine group were treated in converted floor intensive care beds (69.8% vs 58.1%) compared to the prone group.

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

“…These differences could have biased the results toward prone positioning leading to a lower mortality rate. Moreover, the study did not provide details about the duration and frequency of prone positioning and whether the patients who underwent it had any adverse events or complications [ 28 ]. The study by Mathews et al showed a mortality benefit of prone positioning for patients with COVID-19 but also had some caveats.…”