Prone positioning in the COVID-19 pandemic

Real-world data from southern Brazil

Abstract

Introduction: The COVID-19 pandemic rapidly overcrowded hospitals and overwhelmed every aspect of the healthcare systems worldwide, presenting unprecedented challenges for physicians on the front lines managing the increasing number of patients with acute respiratory distress syndrome (ARDS) necessitating respiratory support. The aim of this study was comparing data from patients with COVID-19 submitted to the supine and prone position during the acute phase of ARDS. Methods: In this prospective cohort study demographic and clinical data from 1,545 patients with a positive RT-PCR test for SARS‐CoV‐2, were evaluated. Results: The prone position group was 69.1% male, 58 years old (interquartile range [IQR]:46.0-69.0), 45.1% were admitted to ICU, and 36.4% had ≥50% pulmonary involvement. The profile of patients who required oxygen-therapy was: 91.0% for catheter oxygen, 49.5% for Hudson mask, 36.5% for non-invasive mechanical ventilation (NIMV), and 26.2% for IMV. These patients had a median of 58 years old (IQR: 46.0-69.0), length of stay (LOS) of 11 days (IQR: 7-21), and case-mix of 3.6542 (IQR: 1.7522-5.1284). The clinical variables more prevalent in prone patients were ICU admission, pressure injury, CT graduation ≥50%, LOS, case-mix, dyspnea, oxygen-therapy, corticosteroid, convalescent plasma, vasopressor, and C-Reactive Protein. Conclusion: The results demonstrate differences between the groups regarding their medical history and severity of the current illness, which probably had a great influence on therapeutic decisions and long-term outcomes of these patients.