tetano
Editor, Senior Moderator
Ir J Med Sci
. 2022 Jul 11.
doi: 10.1007/s11845-022-03085-9. Online ahead of print.
Prone positioning for mechanically ventilated patients with coronavirus disease 2019: the experience of an Irish regional hospital intensive care unit
Nicholas Di Mascio[SUP] 1 [/SUP], Siobhan Clarke[SUP] 2 [/SUP], Gillian de Loughry[SUP] 2 [/SUP], Wahid Altaf[SUP] 2 [/SUP]
Affiliations
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 PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] 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. PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] 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 PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio improvement, nor did we find a relationship between degree of PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio improvement and survival.
Keywords: Acute respiratory distress syndrome; COVID-19; Intensive care; Ireland; Oxygenation; Prone positioning.
. 2022 Jul 11.
doi: 10.1007/s11845-022-03085-9. Online ahead of print.
Prone positioning for mechanically ventilated patients with coronavirus disease 2019: the experience of an Irish regional hospital intensive care unit
Nicholas Di Mascio[SUP] 1 [/SUP], Siobhan Clarke[SUP] 2 [/SUP], Gillian de Loughry[SUP] 2 [/SUP], Wahid Altaf[SUP] 2 [/SUP]
Affiliations
- PMID: 35819744
- DOI: 10.1007/s11845-022-03085-9
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 PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] 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. PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] 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 PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio improvement, nor did we find a relationship between degree of PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio improvement and survival.
Keywords: Acute respiratory distress syndrome; COVID-19; Intensive care; Ireland; Oxygenation; Prone positioning.