A Review of the Prone Position in Acute Respiratory Failure Due to Covid-19

Abstract

To improve oxygenation, the prone position is indicated in acute respiratory distress syndrome, being used in critically ill patients. The use of prone position improves the hypoxemic level and reduces mortality when used early. The objective is to identify the indication and main benefits and complications of the prone position in patients admitted to the Intensive Care Unit under mechanical ventilation due to acute respiratory failure due to Covid-19. This is a narrative review of the literature carried out in August 2022, in the Scielo, PubMed and ``Portal de Periódicos Capes`` databases on the clinical indication, benefits and complications of the prone position in patients under mechanical ventilation due to acute respiratory failure due to Covid-19. 19, admitted to the Intensive Care Unit. The Health Sciences descriptors used were "Intensive Care Unit", "Covid-19" and "Prone" (prone position), using the Boolean operator "AND". The original publications were established as inclusion criteria, available in full in Portuguese, English and Spanish, published from 2020 to 2022. As it is a literature review, the study did not require approval from the ethics committee. They resulted in 14 scientific articles, eight from Capes and six from PubMed. Benefits were reported by seven articles, complications by two, and five dealt with the two themes (benefits and complications). Although this review did not make it possible to define the indications for the use of the prone position, some benefits pointed out were the improvement in the PaO2/FiO2 ratio, oxygenation, reduction in length of stay and mortality, and better lung compliance. With regard to complications, pressure injuries and accidental removal of medical devices such as an endotracheal tube and peripheral and central venous accesses occur. Finally, prone positioning was used in intubated and nonintubated patients, with significant PaO2/ FiO2 improvements in prone patients during the Covid-19 pandemic. The limitation in this review is that there is heterogeneity in the studies regarding the pronation criteria, its definition, use, benefits and complications, with cohort methods, cross-sectional studies and with casuistic interventions. Although the pandemic has already ended, retrospective studies are suggested to better investigate the conduct of pronation in patients with Covid-19 in intensive care.