Rapid implementation of a mobile prone team during the COVID-19 pandemic

Abstract

Purpose The coronavirus disease 2019 (COVID-19) is associated with high rates of acute respiratory distress syndrome (ARDS). Prone positioning improves mortality in moderate-to-severe ARDS. Strategies to increase prone positioning under crisis conditions are needed. Material and methods We describe the development of a mobile prone team during the height of the crisis in New York City and describe characteristics and outcomes of mechanically ventilated patients who received prone positioning between April 2, 2020 and April 30, 2020. Results Ninety patients underwent prone positioning for moderate-to-severe ARDS. Sixty-six patients (73.3%) were men, with a median age of 64 years (IQR 53–71), and the median PaO 2 :FiO 2 ratio was 107 (IQR 85–140) prior to prone positioning. Patients required an average of 3 ± 2.2 prone sessions and the median time of each prone session was 19 h (IQR 17.5–20.75). By the end of the study period, proning was discontinued in sixty-seven (65.1%) cases due to clinical improvement, twenty (19.4%) cases due to lack of clinical improvement, six (5.8%) cases for clinical worsening, and ten (9.7%) cases due to a contraindication. Conclusion The rapid development of a mobile prone team safely provided prone positioning to a large number of COVID-19 patients with moderate-to-severe ARDS.

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

“…To date, several groups have approached the problem regarding the creation of a dedicated team in order to better manage the high number of pronations in critically ill COVID-19 patients [ 19 , 21 , 22 , 30 , 31 ]. However, no study reported data concerning the impact of a dedicated team that avails itself of the support of physiotherapists on the incidence of pronation-induced complications.…”

“…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.…”

Development of a Prone Team and Exploration of Staff Perceptions During COVID-19

“…No unnecessary harm to patients by way of dislodgement of endotracheal airway tubes, arterial and central venous monitoring catheters, and drainage catheters occurred. Doussot et al 28 reported 8.8% position-related complications and Short et al 27 reported catheter dislodgement in 1 patient. Our outcomes stand out from those of other colleagues at facilities with dedicated PTs, in part because of the comprehensive training and post-turn debriefings that were conducted, as well as leadership enculturation of a habit of excellence 24 ; staff were treated with respect, given adequate resources, and shown regular appreciation for their efforts.…”

“…Composed of operating room nurses, assistants, and physical therapists who were familiar with critically ill patients and positioning maneuvers, the PT ensured that no additional strain was added to clinical nursing and other bedside clinicians who were already over-burdened with the surge. In a recent article, Short et al 27 supported the importance of familiarity with these skills.…”

Role of physiotherapy team in critically ill COVID-19 patients pronation: can a multidisciplinary management reduce the complications rate?

“…To date, several groups have approached the problem regarding the creation of a dedicated team in order to better manage the high number of pronations in critically ill COVID-19 patients (Cotton et al, 2020;Doussot et al, 2020;Johnson et al, 2021;Ng et al, 2020;Short et al, 2020). However, no studies reported data concerning the impact of a physiotherapy team on the incidence of pronation-induced complications.…”