Short-Term Outcomes of the First-Session Prone Position in Patients With Severe Coronavirus Disease 2019: A Retrospective Chart Review

Makoto Onji; Shinji Kakizoe; Asuka Nakai; Kanami Shimizu; Yosuke Masui; Koichi Naito; Hironori Mikumo

doi:10.7759/cureus.35437

Short-Term Outcomes of the First-Session Prone Position in Patients With Severe Coronavirus Disease 2019: A Retrospective Chart Review

Cureus. 2023 Feb 24;15(2):e35437. doi: 10.7759/cureus.35437. eCollection 2023 Feb.

Authors

Makoto Onji¹, Shinji Kakizoe¹, Asuka Nakai¹, Kanami Shimizu¹, Yosuke Masui², Koichi Naito³, Hironori Mikumo⁴

Affiliations

¹ Department of Rehabilitation, Kitakyushu Municipal Medical Center, Kitakyushu, JPN.
² Department of Nursing, Kitakyushu Municipal Medical Center, Kitakyushu, JPN.
³ Faculty of Medical Science, Nagoya Women's University, Nagoya, JPN.
⁴ Department of Respiratory Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, JPN.

Abstract

Introduction Prone positioning during ventilation is recommended for patients with severe coronavirus disease 2019 (COVID-19). However, the efficacy of first-session prone positioning in improving short-term outcomes remains unclear. Therefore, we aimed to investigate the impact of the rate of change in partial pressure of oxygen/fraction of inspired oxygen (P/F) ratio before and after initial prone positioning on activities of daily living (ADL) and outcomes at discharge. Methods In this retrospective chart review, 22 patients with severe COVID-19 who required ventilator management between April and September 2021 were analyzed. Patients with an improvement in the P/F ratio (after initial prone positioning, compared to that before the session) by > 16mHg and < 16mmHg were defined as responders and non-responders, respectively. Results Compared with non-responders, responders had a significantly shorter ventilator duration, a higher Barthel Index at discharge, and a higher proportion of discharged patients. There was a significant between-group difference in chronic respiratory comorbidities, with one case (7.7%) among responders and six cases (66.7%) among non-responders. Conclusions This study is the first of its kind to investigate short-term outcomes in patients with COVID-19 requiring ventilator management after initial prone positioning. After initial prone positioning, responders had higher P/F ratios as well as improved ADLs and outcomes at discharge.

Keywords: activities of daily living; coronavirus disease 2019; covid-19; mechanical ventilation; prone position; severe coronavirus disease 2019; short-term outcomes.