Prone positioning for patients intubated for severe acute respiratory distress syndrome (ARDS) secondary to COVID-19: a retrospective observational cohort study

Tyler T. Weiss, Flor Cerda, J. Brady Scott, Ramandeep Kaur, Sarah Sungurlu, Sara H. Mirza, Amnah A. Alolaiwat, Ashley E. Augustynovich, Jie Li

Research output: Contribution to journalArticlepeer-review

43 Scopus citations

Abstract

Background: The role of repeated prone positioning in intubated subjects with acute respiratory distress syndrome caused by COVID-19 remains unclear. Methods: We conducted a retrospective observational cohort study of critically ill intubated patients with COVID-19 who were placed in the prone position between March 18, 2020 and March 31, 2020. Exclusion criteria were pregnancy, reintubation, and previous prone positioning at a referring hospital. Patients were followed up until hospital discharge. The primary outcome was oxygenation assessed by partial pressure of oxygen/fraction of inspired oxygen ratio (PaO2/FiO2) ratio. A positive response to proning was defined as an increase in PaO2/FiO2 ratio ≥20%. Treatment failure of prone positioning was defined as death or requirement for extracorporeal membrane oxygenation (ECMO). Results: Forty-two subjects (29 males; age: 59 [52–69] yr) were eligible for analysis. Nine subjects were placed in the prone position only once, with 25 requiring prone positioning on three or more occasions. A total of 31/42 (74%) subjects survived to discharge, with five requiring ECMO; 11/42 (26%) subjects died. After the first prone positioning session, PaO2/FiO2 (mean (standard deviation)) ratio increased from 17.9 kPa (7.2) to 28.2 kPa (12.2) (P<0.01). After the initial prone positioning session, subjects who were discharged from hospital were more likely to have an improvement in PaO2/FiO2 ratio ≥20%, compared with those requiring ECMO or who died. Conclusion: Patients with COVID-19 acute respiratory distress syndrome frequently responded to initial prone positioning with improved oxygenation. Subsequent prone positioning in subjects discharged from hospital was associated with greater improvements in oxygenation.

Original languageEnglish (US)
Pages (from-to)48-55
Number of pages8
JournalBritish Journal of Anaesthesia
Volume126
Issue number1
DOIs
StatePublished - Jan 2021
Externally publishedYes

Keywords

  • acute respiratory distress syndrome (ARDS)
  • COVID-19
  • mechanical ventilation
  • oxygenation
  • prone positioning

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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