Effect of the duration of prone position in ARDS patients during the SARS-CoV-2 pandemic

Abstract

ObjectiveTo describe the characteristics of patients with acute respiratory distress syndrome (ARDS) due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV), and to analyze the effect of prone position >24 h (prolonged) (PPP) compared to prone decubitus <24 h (PP). DesignA retrospective observational descriptive study was carried out, with uni- and bivariate analyses. SettingDepartment of Intensive Care Medicine. Hospital General Universitario de Elche (Elche, Alicante, Spain). ParticipantsPatients with SARS-CoV-2 pneumonia (2020−2021) on IMV due to moderate-severe ARDS, ventilated in prone position (PP). InterventionsIMV. PP maneuvers. Main variables of interestSociodemographic characteristics, analgo-sedation, neuromuscular blockade (NMB), PD duration, ICU stay and mortality, days of IMV, non-infectious complications, healthcare associated infections. ResultsFifty-one patients required PP, and of these, 31 (69.78%) required PPP. No differences were observed in terms of patient characteristics (gender, age, comorbidities, initial severity, antiviral and antiinflammatory treatment received). Patients on PPP had poorer tolerance to supine ventilation (61.29% vs 89.47%, p = 0.031), longer hospital stay (41 vs 30 days, p = 0.023), more days of IMV (32 vs 20 days, p = 0.032), longer duration of NMB (10.5 vs 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39% vs 15%, p = 0.014). ConclusionsPPP was associated with greater resource use and complications in patients with moderate-severe ARDS due to COVID-19.