Hypoxemia and prone position in mechanically ventilated COVID-19 patients: a prospective cohort study
Abstract
To the Editor, During the coronavirus disease (COVID-19) outbreak, patients with severe COVID-19 related acute respiratory distress syndrome (ARDS) were admitted to our tertiary hospital intensive care unit (ICU). The benefits of prone position (PP) on survival have been highlighted in previous ARDS studies. The aim of this study was to report the effects of PP in mechanically ventilated patients with COVID-19 related ARDS. Between 1 March 2020 and 30 April 2020, we prospectively included all patients admitted to our ICU with COVID-19 related acute respiratory failure. COVID19 was diagnosed by real-time reverse transcription polymerase chain reaction (rRT-PCR) test on a nasopharyngeal swab. During this period, 70 patients with confirmed COVID-19 were admitted; 64 (91%) received invasive mechanical ventilation during the course of the disease. They were ventilated with low tidal volume (B 6 mL kg), plateau pressure below 30 cmH2O, low driving pressure (B 15 cmH2O), and positive end-expiratory pressure according to the strategy proposed by the ARDS Network. Patients for whom the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FIO2) ratio remained below 150 for 12 hr despite this protective ventilation received at least one 16-hr PP session (flow chart, eFigure in Electronic Supplementary Material [ESM]). All patients were sedated and paralyzed before PP. Respiratory parameters were recorded before and at the end of the first 16-hr PP session. The…
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