Effect of Prone Position on Oxygenation Parameters of Intubated Patients Due to COVID-19-Related ARDS: Prospective Observational Study.

BACKGROUND

Prone positioning (PP) is widely used to improve oxygenation in acute respiratory distress syndrome (ARDS), but evidence in mechanically ventilated COVID-19 ARDS is heterogeneous.

AIM: To evaluate the effect of 16-h daily PP on oxygenation, ventilation, laboratory and radiological parameters in intubated patients with COVID-19-related ARDS.

STUDY

DESIGN

In this prospective cohort, 40 intubated patients were followed for 3 days: PP group (n = 20; PaO2/FiO2 ≤ 100) and supine position (SP) group (n = 20; PaO2/FiO2 ≤ 200). Ventilator settings, oxygenation/ventilation parameters (PaO2, PaCO2, HCO3, lactate, pH and SaO2), PaO2/FiO2 ratio, haematologic/biochemical markers (C-reactive protein (CRP), fibrinogen, D-dimer, ferritin, lymphocyte count, procalcitonin, platelet count and LDH) and daily chest radiographs were recorded.

RESULTS

Within-group analyses in the PP group showed significant changes over time in PaO2 (p = 0.024), PaCO2 (p = 0.035), PaO2/FiO2 (p < 0.001), pH (p = 0.004), fibrinogen (F = 7.600; p = 0.002), procalcitonin (F = 3.828; p = 0.043), platelet count (F = 6.486; p = 0.013), and LDH (F = 8.862; p = 0.002) no significant within group changes were observed in the SP group (fibrinogen, p = 0.068; procalcitonin p = 0.093; platelet p = 0.068; LDH p = 0.227). SaO2 was higher in the PP group than in the SP group at M3 on Day 2: PP: 92.13 ± 5.5 vs. SP: 88.24 ± 6.02%; t = 2.131; mean difference +3.89 (95% CI 0.19 to 7.57; p = 0.040). CRP decreased over time in both groups (PP: p = 0.008; SP: p = 0.001). Radiographically, ground-glass opacities decreased in 70% of PP vs. 25% of SP patients (p = 0.001).

CONCLUSIONS

This study suggests that the prone position may be more effective in improving clinical and oxygenation parameters in intubated COVID-19 patients with severe ARDS.

RELEVANCE TO CLINICAL PRACTICE: This study provides evidence to guide the management of COVID-19-related ARDS. The findings may support ICU nurses' clinical decisions and improve care protocols for similar patients. Clinically, maintaining ARDS patients in the prone position (PP) aids recovery. In intensive care units, experienced nurses should ensure correct patient positioning and provide continuous monitoring.