Prone Positioning for Severe Acute Respiratory Distress Syndrome in COVID-19 Patients by a Dedicated Team

Abstract

Objective: The aim of this study was to define whether rapidly reallocating health care workers not experienced with PP for performing PP in ICU is feasible and safe. Summary Background Data: In the setting of severe acute respiratory distress syndrome (ARDS), the use of prone and supine positioning procedures (PP) has been associated with improved oxygenation resulting in decreased mortality. Nevertheless, applying PP is time consuming for ICU staffs that are at risk of mental of physical exhaustion, especially with the constant surge of admitted COVID-19 patients with severe ARDS. Methods: This prospective cohort study conducted at a single regional university hospital between March 27 and April 15, 2020. Among 117 patients admitted to ICU, 67 patients (57.3%) presented with proven SARS-CoV-2 infection with severe ARDS requiring PP. After accelerated simulation training, 109 volunteers including surgeons, physicians, nurses and physiotherapists, multiple dedicated teams performed daily multiple PP following a systematic checklist. Patient demographics and PP data were collected. Patient safety and health care workers safety were assessed. Results: Among 117 patients admitted to ICU, 67 patients (57.3%) required PP. Overall, 53 (79%) were male, with a median age of 68.5 years and median body mass index of 29.3 kg/m 2 . A total of 384 PP were performed. Overall, complication occurred in 34 PP (8.8%) and led to PP cancelation in 4 patients (1%). Regarding health care workers safety, four health care workers presented with potential COVID-19 related symptoms and none was positive. Conclusions: To overcome the surge of critically ill COVID-19 patients, reallocating health care workers to targeted medical tasks beyond their respective expertise such as PP was safe.

Multidisciplinary team approach in critically ill COVID-19 patients reduced pronation-related complications rate: A retrospective cohort study

“…Similarly, some groups addressed the incidence of pronation-related complications in critically ill COVID-19 patients [ 19 , 20 ]. In this setting, Short et al [ 21 ] reported a clinical benefit in having a specific “pronation team” dedicated to patients’ pronation during the pandemic wave [ 22 ], even though they focused mainly over clinical patients evolution, rather than over the rate of complications related to this delicate procedure.…”

The Fundamentals of Respiratory Physiology to Manage the COVID-19 Pandemic: An Overview

“…Innovative solutions have been found worldwide to cope with limited resources and to include the prone positioning in the management of patients requiring mechanical ventilation, even at the surge of the outbreak, resulting in the emergence of prone teams ( Doussot et al, 2020 ; Kimmoun et al, 2020 ; Settembre et al, 2020 ).…”

Décubitus ventral dans les cas d’insuffisance respiratoire hypoxémique liés à la COVID-19

“…Comme les études de modélisation ont évoqué une telle possibilité pour les hôpitaux canadiens si les mesures demandées par la santé publique ne sont pas respectées 35,36 , les hôpitaux devraient par conséquent préparer ou adopter des lignes de conduite concernant le décubitus ventral, promouvoir un transfert rapide des connaissances et la formation du personnel clinique. À titre d'exemple, Doussot et ses collègues ont décrit la création d'une équipe spécialisée pour le décubitus ventral dans un hôpital régional en France 37 . Chirurgiens, personnel infirmier, physiothérapeutes et autres professionnels de la santé ont accepté de recevoir la formation, qui incluait une liste de vérification, une simulation et une formation sur l'utilisation appropriée de l'EPI 37 .…”

“…À titre d'exemple, Doussot et ses collègues ont décrit la création d'une équipe spécialisée pour le décubitus ventral dans un hôpital régional en France 37 . Chirurgiens, personnel infirmier, physiothérapeutes et autres professionnels de la santé ont accepté de recevoir la formation, qui incluait une liste de vérification, une simulation et une formation sur l'utilisation appropriée de l'EPI 37 .…”