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Observational Study
. 2023 Jun;192(3):1329-1334.
doi: 10.1007/s11845-022-03085-9. Epub 2022 Jul 11.

Prone positioning for mechanically ventilated patients with coronavirus disease 2019: the experience of an Irish regional hospital intensive care unit

Nicholas Di Mascio  1 , Siobhan Clarke  2 , Gillian de Loughry  2 , Wahid Altaf  2
Affiliations
Observational Study

Prone positioning for mechanically ventilated patients with coronavirus disease 2019: the experience of an Irish regional hospital intensive care unit

Nicholas Di Mascio et al. Ir J Med Sci. 2023 Jun.

Abstract

Background: The benefits of prone positioning in acute respiratory distress syndrome (ARDS) have been known for many years. While some controversy exists regarding whether coronavirus disease 2019 (COVID-19) pneumonia should be treated with the same therapeutic strategies as for non-COVID ARDS, the Surviving Sepsis Campaign still provide a weak recommendation to utilise prone positioning in this setting.

Aims: The aims of this study are to ascertain if prone positioning improves oxygenation significantly in mechanically ventilated patients with severe COVID-19 ARDS and to describe the feasibility of frequent prone positioning in an Irish regional hospital intensive care unit (ICU) with limited prior experience.

Methods: In this retrospective, observational cohort study, we investigate if the PaO2/FiO2 ratio and ventilatory ratio improve during and following prone positioning, and whether this improvement correlates with patient baseline characteristics or survival.

Results: Between March 2020 and 2021, 12 patients underwent prone positioning while mechanically ventilated for severe COVID ARDS. Sixty-six percent were male, mean age 60.9 (± 10.5), mean BMI 33.5 (± 6.74) and median APACHE II score on admission to ICU was 10.5 (7.25-16.3). Further, 83% were proned within 24 h of being intubated due to refractory hypoxaemia. PaO2/FiO2 ratio improved from 11.6 kPa (9.80-13.8) to 15.80 kPa (13.1-19.6) while prone, p < 0.0001.

Conclusions: We found prone positioning to be a safe method of significantly improving oxygenation in mechanically ventilated patients with severe COVID-19 ARDS. We did not find a relationship between patient baseline characteristics nor illness severity and degree of PaO2/FiO2 ratio improvement, nor did we find a relationship between degree of PaO2/FiO2 ratio improvement and survival.

Keywords: Acute respiratory distress syndrome; COVID-19; Intensive care; Ireland; Oxygenation; Prone positioning.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Management of patients admitted to the Intensive Care Unit (ICU) with COVID-19 Acute Respiratory Distress Syndrome (ARDS) between March 2020 – March 2021
See this image and copyright information in PMC

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