Effect of early prone positioning among critically ill patients admitted with acute respiratory distress syndrome during the COVID-19 pandemic: A comparative retrospective observational study

Abstract

Background and objective: COVID-19 has offered an opportunity to the clinicians to try and study various oxygenation enhancing maneuvers in the patients. These included lung protective measures and prone positioning of participants admitted to the ICU with acute respiratory distress syndrome. We aimed to identify the effects of early prone positioning on the length of stay, discharge rate, and frequency of tracheostomies in the ICU patients.

Methodology: This retrospective study was conducted on critically ill patients needing mechanical ventilation with lung protective strategy, admitted to the Intensive Care Units of Al-Azhar University Hospitals between March 2020 to April 2022. All patients in the study were interpreted retrospectively by examining the patient's records. Group A (n = 39) included patients who had been early placed in prone positions within 24 h of intubation, and Group B (n = 31) included patients who had not been placed in prone positions. All patients received a lung protective strategy for ARDS.  In both groups, PaO₂, PaCO₂, pH, SpO₂, and PaO₂/FiO₂ ratio were checked initially and later every 24 h for 6 days. Data was evaluated for the total days of both hospital and ICU length of stay, number of successful discharges to home from the hospital, and the total number of tracheostomized patients.

Results: After prone positioning, lower SOFA and APACHE II scores were noticed in the prone group.  There was no significant difference in the rate of discharge between the two groups. We observed non-significant shorter hospital and ICU stays and higher frequency of tracheostomy procedures in the prone group. We noticed a significant improvement in PaO₂/FiO₂ ratios in the prone group starting from day 2 to day 6. We observed a significant improvement in PO₂ in the prone group in comparison to the non-prone group.

Conclusions: Early prone positioning of patients admitted to the ICU with acute respiratory distress syndrome during COVID-19 pandemic led to a significant improvement in both PaO₂ and PaO₂/FiO₂ ratio with a non-significant decrease in both hospital and ICU length of stay as shown by the collected data over consecutive six days.

Abbreviations: ARDS- acute respiratory distress syndrome; FiO₂: The fraction of inspired oxygen; CPAP: Continuous Positive Airway Pressure; PaO₂: Arterial oxygen partial pressure; PEEP: Positive End-Expiratory Pressure; SOFA- Sequential Organ Failure Assessment

Keywords: Prone; Lung protective measures; ARDS; APACHI II; SOFA

Citation: Seyam SHA, Ahmed IMA. Effect of early prone positioning among critically ill patients admitted with acute respiratory distress syndrome during the COVID-19 pandemic: a comparative retrospective observational study. Anaesth. pain intensive care 2024;28(4):626−632; DOI: 10.35975/apic.v28i4.2504

Received: February 12, 2024; Reviewed: May 14, 2024; Accepted: May 15, 2024