Prone position in wards for spontaneous breathing Covid-19 patients: a retrospective study

Abstract

The pandemic of coronavirus disease 2019 (Covid-19) caused a large number of non-ventilated hypoxemic patients to require the use of prone position. The aim of this study is to measure the efficiency and tolerance of prone positioning in ward hypoxemic patients treated for Covid-19. This retrospective study included confirmed Covid-19 hypoxemic patients treated by at least one prone position session. Primary outcome was pulse oximetry over inspired oxygen fraction ratio (SpO2/FiO2) before, during, and after prone position. Secondary outcomes were failure, adverse events, and poor tolerance rate. Twenty-seven patients were included. During first, second and third sessions, SpO2/FiO2 ratio was significantly higher during posture than before (p < 0.0001, p < 0.01, and p < 0.001 respectively). Eighteen patients were responders (defined as an improvement of SpO2/FiO2 of more than 50) during the first posture and have a shorter length of hospital stay than non-responder patients. Failure rate was 5%, and poor tolerance and adverse events rates were 8% and 7% respectively. Our study found that prone position in wards improved alveolar exchange during posture and is well tolerated. This technique could be used in any medical ward.

Keywords: Acute respiratory failure; Covid-19; Hypoxemia; Oxygenation; Tolerance; Wards.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2021. Royal Academy of Medicine in Ireland.

Figures

Fig. 1

SpO2/FiO2 ratio before, during, and after prone position. a First prone position (n = 24): ****p < 0.0001 between before and during prone position. b Second prone position (n = 15): **p < 0.01 between before and during prone position. c Third prone position (n = 13): ***p < 0.001 between before and during prone position. PP, prone position; ns, non-significance