Effects of modular new prone positioning tools in patients with acute respiratory distress syndrome due to COVID-19: A randomized controlled trial

Abstract

Background Prone position (PP) ventilation has become an effective and simple treatment for acute respiratory distress syndrome (ARDS) due to COVID-19; however, prolonged prone position not only leads to patient discomfort, but also reduces patient compliance, and is prone to causing adverse events such as pressure injuries, pain, and dizziness. We aim to explore the effects of modular new prone positioning tools in patients with ARDS due to COVID-19. Methods 168 patients with ARDS due to COVID-19 were selected; however, 92 were later disqualified. 76 patients were randomly assigned to the observation group (n = 38) and the control group (n = 38). The observation group used modular new prone positioning tools to implement prone ventilation therapy while the control group used soft pillows to implement prone ventilation therapy. Comfort indicators (including time spent implementing PP, duration of PP, number of postural adjustments during PP, and duration time when first needing to adjust position), adverse events (including artificial airway kinking, shortness of breath, dizziness, and stress injury), and efficacy indicators (including intubation and mortality) were collected. The feeling of comfort, the occurrence of adverse events, and the efficacy of two groups of patients were also evaluated. Results The observation group had shorter time spent implementing PP(2.74 ± 0.86 vs. 4.64 ± 1.02, P < 0.001), longer duration of PP (14.02 ± 1.01 vs. 13.03 ± 0.66, P < 0.001), duration time when first needing to adjust position (59.89 ± 12.73 vs. 36.57 ± 8.69, P < 0.001), and lower number of postural adjustments during PP (11.03 ± 2.67 vs. 17.95 ± 2.58, P < 0.001) in comparison with the control group. No significant differences in intubation (9 vs. 11, P = 0.602) and mortality (4 vs. 6, P = 0.602) were found in both groups. However, in terms of adverse events, the observation group showed lower artificial airway kinking (5 vs. 23, P < 0.001), pain (7 vs. 21, P = 0.001), shortness of breath (2 vs. 9, P = 0.022), dizziness (0 vs. 5, P = 0.021), and stress injury (7 vs. 26, P < 0.001) than the control group. Conclusion Utilizing modular new prone position tools to implement prone ventilation therapy not only improves the efficiency of prone position execution and patient comfort, but also reduces the incidence of adverse events. However, it cannot change the intubation rate and mortality rate of patients.