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. 2023 Jun;192(3):1321-1325.
doi: 10.1007/s11845-022-03079-7. Epub 2022 Jul 1.

Evaluation of the efficiency and complications of the consecutive proning in COVID-19 ICU: a retrospective study

Esra Ozayar  1 , Ozlem Ozbek  2 , Adem Selvi  2 , Adil Ozturk  2 , Ozge Gursozlu  2
Affiliations

Evaluation of the efficiency and complications of the consecutive proning in COVID-19 ICU: a retrospective study

Esra Ozayar et al. Ir J Med Sci. 2023 Jun.

Abstract

Purpose: We aimed to evaluate and compare the efficacy and complications of three consecutive prone positions (PP) in COVID-19 ICU.

Materials and method: Patients with ARDS and placed in PP for 3 times (PP1, PP2, PP3) consecutively were included. Arterial blood gases (ABG), partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratios, partial pressure of carbondioxide (PaCO2), PEEP, and FiO2 were recorded before (bPP), during (dPP), and after (aPP) every prone positioning. Eye, skin, nerve, and tube complications related to PP were collected.

Results: In all positions, PaO2 value during PP was significantly higher than PaO2 before and after prone position (p = 0.001). PaO2 values were similar in all (PP1, PP2, PP3) bPP arterial blood gases. We found difference in PaO2 values during prone position between the first (PP1) and second proning (PP2). When each prone was evaluated within itself, PaO2/FiO2 increases after proning compared to before proning. PaO2/FiO2 during PP were higher compared to before proning ones. PaO2/FiO2 during PP1 was significantly higher compared to during PP3 (p = 0.005). In PP3, PEEP values bPP, dPP, and aPP were significantly higher than PEEP values after the second prone (p = 0.02, p = 0.001, p = 0.01). In the third prone, PaCO2 levels were higher than in PP1 and PP2. There were eye complications in 13, tube-related complications in 10, skin complications in 30, and nerve damage in 1 patient.

Conclusion: We believe that a more careful decision should be made after the second prone position in patients who have to be placed in sequential prone position.

Keywords: Covid -19; Intensive Care Unit; Prone position.

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Figures

Fig. 1
Fig. 1
Partial oxygen pressure levels before prone position (bPP), during prone position (dPP), and after prone position (aPP) in the first prone position (PP1), second prone position (PP2), and third prone position (PP3)
Fig. 2
Fig. 2
Fraction of inspired oxygen (FiO2) levels before prone position (bPP), during prone position (dPP), and after prone position (aPP) in the first prone position (PP1), second prone position (PP2), and third prone position (PP3)
Fig. 3
Fig. 3
Partial oxygen pressure/fraction of inspired oxygen ratio, before prone position (bPP), during prone position (dPP), and after prone position (aPP) in the first prone position (PP1), second prone position (PP2), and third prone position (PP3)
Fig. 4
Fig. 4
Positive end-expiratory pressure (PEEP), before prone position (bPP), during prone position (dPP), and after prone position (aPP) in the first prone position (PP1), second prone position (PP2), and third prone position (PP3)
Fig. 5
Fig. 5
Partial carbon dioxide presure (PaCO2), before prone position (bPP), during prone position (dPP), and after prone position (aPP) in the first prone position (PP1), second prone position (PP2), and third prone position (PP3)
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