Physiological effect of prone positioning in mechanically ventilated SARS-CoV-2- infected patients with severe ARDS: An observational study

  1. Avishek Roy
  2. Srikant Behera
  3. Aparna Pande
  4. Anirban Bhattacharjee
  5. Amrita Bhattacharyya
  6. Dalim K. Baidya
  7. Rahul K. Anand
  8. Bikash R. Ray
  9. Rajeshwari Subramaniam
  10. Souvik Maitra

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Abstract

Mechanical ventilation in prone position was associated with a reduction in mortality and increase in arterial oxygenation in acute respiratory distress syndrome (ARDS) patients. However, physiological effects of prone position in COVID ARDS patients are unknown.

Material and Methods:

In this prospective observational study, data of n = 47 consecutive real time RT- PCR confirmed SARS-CoV-2-infected patients with severe ARDS were included. Respiratory mechanics and oxygenation data of recruited patients were collected before and after prone position.

Results:

Median (Interquartile range, IQR) age of the recruited patients was 60 (50–67) years and median (IQR) PaO 2 /FiO 2 ratio of 61.2 (54–80) mm Hg with application of median (IQR) positive end expiratory pressure (PEEP) of 12 (10–14) cm H2O before initiation of prone position. Out of those patients, 36 (77%) were prone responders at 16 hours after prone session, evident by increase of PaO2 by at least 20 mm Hg or by 20% as compared to baseline, and 73% patients were sustained responders (after returning to supine position). Plateau airway pressure (p < 0.0001), peak airway pressure (p < 0.0001), and driving pressure (p < 0.0001) were significantly reduced in prone position, and static compliance (p = 0.001), PaO 2 /FiO 2 ratio (p < 0.0001), PaO 2 (p = 0.0002), and SpO 2 (p = 0.0004) were increased at 4 hours and 16 hours since prone position and also after returning to supine position.

Conclusion:

In SARS-CoV-2-infected patients, mechanical ventilation in prone position is associated with improvement in lung compliance and oxygenation in almost three-fourth of the patients and persisted in supine position in more than 70% of the patients.

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  1. Version published to 10.4103/joacp.joacp_282_21
  2. ScreenIT

    SciScore for 10.1101/2020.09.16.20195958: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Permission from the Institute Ethics Committee was obtained before recruitment of first patient and consent was obtained from legally acceptable representative of all recruited patients.
    Consent: Permission from the Institute Ethics Committee was obtained before recruitment of first patient and consent was obtained from legally acceptable representative of all recruited patients.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All collected data were entered in a Microsoft Excel datasheet.
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)
    All statistical analyses were performed using GraphPad Prism version 8.0.0 for Mac OS, (
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    (GraphPad Software, San Diego, California USA).
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has few limitations such as sample size was small, and we couldn’t assess the effect of prone position on chest wall and lung compliance separately as esophageal manometry was not used.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.09.16.20195958v1 on medRxiv