Use of the Prone Position in Critically Ill COVID-19 Patients: Can the Response Be Predicted?

Background: Coronavirus disease 2019 (COVID-19) can cause acute respiratory failure and acute respiratory distress syndrome (ARDS). The prone position (PP) is widely used in patients with severe hypoxemia due to ARDS as it improves oxygenation. The aim of this study was to investigate whether improvements in gas exchange and lung mechanics with the PP were associated with survival in ventilated COVID-19 patients. Methods: Fourteen ventilated patients who were placed in the PP were included from May to June 2021. Clinical manifestations and lung mechanics parameters were collected. Results: The overall intensive care unit (ICU) mortality rate was 42.9%. Nonsurvivors were older (p = 0.014) and had higher Charlson comorbidity index (2.1 +/- 1.5 vs. 4.8 +/- 2.4, p = 0.035) and Sepsis-related Organ Failure Assessment (SOFA) (3.3 +/- 1.0 vs. 7.3 +/- 3.5, p = 0.019) scores compared to survivors. There was no difference in PaO2/FiO(2) (P/F ratio) at baseline between the survivors and nonsurvivors. The improvement in P/F ratio (p = 0.0037) and reduction in driving pressure (Pdrive) (p = 0.046) on the second day after first PP were correlated with lower mortality. Significant predictors of successfully stopping prone treatment included a reduction in Pdrive at the first hour, lower tidal volume (Vt) at the fourth hour, and P/F ratio improvement on the second day after PP. Conclusion: Improvement in P/F ratio and reduction in driving pressure on the second day after PP were correlated with reduced mortality. Three parameters could predict successful resumption of the supine position. Copyright (c) 2022, Taiwan Society of Geriatric Emergency & Critical Care Medicine.