The Positive Effects of Manual Pronation in a United States Community Based Hospital Intensive Care Unit During the COVID-19 Surge Crisis

Abstract

Background
 Patients in acute respiratory distress syndrome suffer a high mortality rate; however, manual pronation has a survival advantage up to 17% (Gattinoni, 2013). March 2020 marked the initial COVID-19 surge in the US, characterized by government lock-downs, inundation of healthcare systems, and high patient fatality levels. Initially, COVID-19 patients who might benefit from manual pronation were transferred to other local facilities until our interdisciplinary team implemented a manual pronation policy within 27 days of receiving our first COVID-19 positive patient.
 Aim
 The aim of this study was to describe the impact of a community hospital partaking in manual pronation for the first time, quality care metrics—specifically Central Line-Associated Bloodstream Infections (CLABSIs), Catheter-Associated Urinary Tract Infections (CAUTIs), and Ventilator-Associated Pneumonia/Events (VAP/VAEs)—associated with the COVID-19 surge, and the barriers overcome during this process.
 Methods
 This retrospective data collection study included hypoxemia, intubation, discharge and quality safety data from March 13 to June 1, 2020 for patients who underwent manual pronation.
 Results/Findings 
 Pronation occurred a total of twenty-seven times in 13 patients (seven (53.8%) survived and six (46.2%) died during hospital admission). Four (57.1%) of the patients who survived were discharged home, two (28.6%) went to a rehabilitation facility, and one (14.3%) was transferred to an outside hospital. Zero CAUTIs (458 catheter days), CLABSIs (371 central line days), and VAEs (384 ventilator days) occurred during the study.
 Conclusions
 With the newly acquired proning policy in place and creative COVID-19 care, data were consistent with an overall improvement in patient outcomes. Manual pronation was shown to improve P/F ratios. There were no upticks in hospital acquired infections, notably CAUTIs, CLABSIs, and VAP/VAEs at our facility.