Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

Andrei Karpov; Anish R Mitra; Sarah Crowe; Gregory Haljan

doi:10.1155/2020/6688120

Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

Crit Care Res Pract. 2020 Nov 12:2020:6688120. doi: 10.1155/2020/6688120. eCollection 2020.

Authors

Andrei Karpov^{1

2}, Anish R Mitra^{1

3}, Sarah Crowe⁴, Gregory Haljan^{1

3}

Affiliations

¹ Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
² Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
³ Division of Critical Care Medicine, Department of Medicine, Surrey Memorial Hospital, Surrey, BC, Canada.
⁴ Division of Critical Care Medicine, Department of Nurse Practitioners, Surrey Memorial Hospital, Surrey, BC, Canada.

Abstract

Design: This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team.

Conclusions: The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.