Rapid implementation of a mobile prone team during the COVID-19 pandemic

Abstract

Purpose: The coronavirus disease 2019 (COVID-19) is associated with high rates of acute respiratory distress syndrome (ARDS). Prone positioning improves mortality in moderate-to-severe ARDS. Strategies to increase prone positioning under crisis conditions are needed.

Material and methods: We describe the development of a mobile prone team during the height of the crisis in New York City and describe characteristics and outcomes of mechanically ventilated patients who received prone positioning between April 2, 2020 and April 30, 2020.

Results: Ninety patients underwent prone positioning for moderate-to-severe ARDS. Sixty-six patients (73.3%) were men, with a median age of 64 years (IQR 53-71), and the median PaO₂:FiO₂ ratio was 107 (IQR 85-140) prior to prone positioning. Patients required an average of 3 ± 2.2 prone sessions and the median time of each prone session was 19 h (IQR 17.5-20.75). By the end of the study period, proning was discontinued in sixty-seven (65.1%) cases due to clinical improvement, twenty (19.4%) cases due to lack of clinical improvement, six (5.8%) cases for clinical worsening, and ten (9.7%) cases due to a contraindication.

Conclusion: The rapid development of a mobile prone team safely provided prone positioning to a large number of COVID-19 patients with moderate-to-severe ARDS.

Keywords: Acute respiratory distress syndrome (ARDS); Coronavirus disease 2019 (COVID-19); Prone positioning.

Fig. 1

Number of interventions per day: Daily number of interventions completed by the prone team. Includes placing in both the supine and prone position. X axis represents dates in April 2020.