Prone Position Versus Supine Position Effects On Intubated Patients With COVI-D19

Abstract

Background: Prone positional treatment has demonstrated a reduction in mortality for severe hypoxia associated with Acute Respiratory Distress Syndrome (ARDS) by approximately fifty percent.  These patients exhibit a response to positional therapy akin to that of other individuals with severe hypoxemic ARDS, despite the distinct characteristics of hypoxemic lung collapse induced by COVID-19 (Coronavirus Disease 2019, SARS-CoV-2).

Aim: This study aimed to compare outcomes between prone versus supine position in intubated patients with COVID-19.

Patients and methods: This study looked back at COVID-19 cases that occurred at Elsahel Hospital between 2021 and 2022.  Because this was a retrospective study, we did not need patients' explicit consent.   The study included 150 adults (≥ 18 years old) with ARDS who were admitted to the intensive care unit and underwent an intubation, as well as a confirmed SARS-CoV-2 infection as shown by positive results from real-time reverse transcriptase-polymerase chain reaction assays of nose and pharyngeal swabs.   Upon admission to the intensive care unit, clinical data were gathered.   Every day, data was collected regarding the prone position's application.   Results were tracked by following up with patients.

Results: One hundred fifty COVID-19 patients were the subjects of this retrospective investigation.  Out of the total number of patients treated in the intensive care unit, 111 (or 74% of the total) were turned prone at least once, whereas 39 (or 26% of the total) were treated while lying down.  There were statistically significant differences (p<0.05) between the prone and supine positions, with the prone position exhibiting considerably greater neutrophil, LDH, and serum ferritin levels.  The study found that patients in the prone position had lower lymphocyte and eosinophil counts compared to those in the supine position (p<0.05). Additionally, the prone position patients had higher respiratory rate, PaO2/FIO2 ratio, PaO2, and PEEP counts (p<0.05) than the supine position patients.  Patients in a prone position had a significantly lower FiO2 and a longer duration of stay in the intensive care unit (ICU) compared to patients in a supine position, with statistical significance (p<0.05) for both variables.

Conclusion: During the COVID-19 pandemic, patients with respiratory failure receiving mechanical ventilation have often been treated in the prone position. When in the prone position, the majority of patients' oxygenation rose, most likely due to better ventilation perfusion matching.