Physiological Changes During Prone Positioning in COVID-19 Acute Respiratory Distress Syndrome

Abstract

Letter to the Editor Dear Editor, Prone positioning is an established treatment modality in acute respiratory distress syndrome (ARDS) and has been employed in the management of ARDS in severe 2019 novel coronavirus disease (COVID-19) in the intensive care unit (ICU) with varying clinical and physiological responses. 1,2 To date, Singapore has seen 44,122 COVID-19 patients, with the majority of inpatients managed at National Centre of Infectious Diseases (NCID). NCID ICU has managed 36 mechanically intubated patients thus far. We retrospectively examine the first 20 patients in NCID ICU and describe our early experience of prone positioning in COVID-19 ARDS including identifying potential early physiological indicators of poor response to prone positioning.

Prone position in COVID 19-associated acute respiratory failure

“…Therefore, the aim to identify patient who will respond most positively to prone position is crucial. Fifteen studies had PaO 2 /F I O 2 data available before and during proning [3 && , [35][36][37][38][39][40][41][42][43][44][45][46][47][48]. The ratio increased by 52 (38-66) mmHg (P < 0.01), when the heterogeneity was significant (I 2 ¼ 93%).…”

One Year on: An Overview of Singapore’s Response to COVID-19—What We Did, How We Fared, How We Can Move Forward

“…COVID-19 diagnostic testing [256][257][258][259][260][261][262][263][264][265] was also discussed, from the current testing processes available [256][257][258][259]261,264,265] to the workflows for diagnosis [260,262,263]. Some articles described COVID-19 treatment [266][267][268][269][270][271][272][273][274][275][276], ranging from assessing the pharmacological options [274,276] to other forms of management, such as prone positioning [267,270]. Various aspects of the molecular pathology of COVID-19 [277][278][279][280][281][282][283] were studied as well, such as the T-cell response [277] and the viral spike protein [278].…”

“…The incubation period of locally acquired COVID-19 cases ranged from 1 to 12 days with a median of 5 days, supporting the use of 14 days as a quarantine period for suspected cases [250]. Regarding the treatment of COVID-19, it is still a fresh area of evolving research, but early studies have shown prone positioning to be a low-cost and effective measure in improving outcomes [267,270].…”