C. Gaspari1, R. Freire1, A. Silva1, C. Santiso1, I. Assumpção1, P. Kurtz2
1Instituto Estadual do Cérebro Paulo Niemeyer, Physical Therapy, Rio de Janeiro, Brazil, 2Instituto Estadual do Cérebro Paulo Niemeyer, Intensive Care Medicine, Rio de Janeiro, Brazil
Background: Patients with coronavirus disease 2019 (COVID-19) are at increased risk for acute respiratory distress syndrome (ARDS). Prolonged prone positioning (PP) has been shown to be safe, to improve oxygenation and decrease mortality in patients with severe ARDS requiring mechanical ventilation.
Purpose: The purpose of this study was to report the outcome and the use of this type of ventilation strategy in critically ill patients with COVID-19.
Methods: This retrospective, single-center study was conducted among patients with confirmed SARS-CoV-2 and acute respiratory failure requiring intubation and PP ventilation. The patients were hospitalized from March 17 to June 22, 2020. Data extracted from electronic medical records included: demographics, mechanical ventilation parameters (PEEP and FiO2), PaO2, patient disposition, and adverse events related to PP maneuver.
Patients were considered successful responders of the PP maneuver if there was a PaO2:FiO2 increase ≥20% before and during PP. Data are expressed as numbers (%) or medians and interquartile range (25th to 75th percentile).
Patients were considered successful responders of the PP maneuver if there was a PaO2:FiO2 increase ≥20% before and during PP. Data are expressed as numbers (%) or medians and interquartile range (25th to 75th percentile).
Results: The PP maneuver was performed 78 times in 38 patients who underwent mechanical ventilation. Of these patients, 29% (11) were female and 71% were male (27). Of the 78 maneuvers, there were 60 (77%) responders and 18 (23%) non-responders.
The median positive end expiratory pressure (PEEP) used was 12 cm H20 (14-12) and the median FiO2 was 80% (100-70).There was no loss of artificial airway devices (endotracheal tube or tracheostomy) in all 78 PP maneuvers performed.
Twenty one percent of patients (8) were discharged home, 18% (7) were transferred from the ICU to step down units, and 61% (23) died. There were no nonscheduled extubation events or any complications that led to the immediate interruption of PP.
The median positive end expiratory pressure (PEEP) used was 12 cm H20 (14-12) and the median FiO2 was 80% (100-70).There was no loss of artificial airway devices (endotracheal tube or tracheostomy) in all 78 PP maneuvers performed.
Twenty one percent of patients (8) were discharged home, 18% (7) were transferred from the ICU to step down units, and 61% (23) died. There were no nonscheduled extubation events or any complications that led to the immediate interruption of PP.
Conclusion(s): Despite the known high overall mortality of critically-ill patients with COVID-19, PP was considered effective in 60% of the maneuvers with an immediate increase (>20%) in PaO2:FiO2 values before and during PP, thereby improving oxygenation.
There were no adverse events associated with the PP maneuvers, indicating that it was a safe procedure to be performed in these patients.
Further studies are needed to determine mortality and long-term outcomes.
There were no adverse events associated with the PP maneuvers, indicating that it was a safe procedure to be performed in these patients.
Further studies are needed to determine mortality and long-term outcomes.
Implications: PP in patients with COVID-19 with severe hypoxemia showed improvement in oxygenation in 60% of maneuvers.
Funding, acknowledgements: None
Keywords: Prone position ventilation, COVID-19, ARDS
Topic: COVID-19
Did this work require ethics approval? Yes
Institution: Instituto Estadual do Cérebro Paulo Niemeyer
Committee: Comitê de Ética Instituto Estadual do Cérebro Paulo Niemeyer
Ethics number: CAAE: 32150020.3.0000.8110
All authors, affiliations and abstracts have been published as submitted.
