Application of prone position ventilation in ventilation strategies for patients with COVID-19

Abstract

BACKGROUND:

Patients with coronavirus disease 2019 (COVID-19) have been shown to die mainly due to disease-induced acute respiratory distress syndrome (ARDS). Prone position ventilation (PPV) is an important ventilation strategy in the management of patients with ARDS.

OBJECTIVE:

To investigate the application of PPV in ventilation strategies for patients with COVID-19.

METHODS:

Three hundred patients with COVID-19 admitted to the Intensive Care Unit (ICU) of Shanxi Bethune Hospital from January 2020 to June 2021 were retrospectively collected. Based on body position and conscious state, all patients were divided into three groups: intubation prone position group ( $n=$ 110), awake prone position group ( $n=$ 90) and supine position group ( $n=$ 100); The acute physiology and chronic health evaluation II (APACHE-II) scores, blood gas indicators, complications and other relevant clinical indicators were compared among the three groups. One-way ANOVA was used to compare means between multiple groups for quantitative information that conformed to a normal distribution. Repeated measures ANOVA was used for repeated measures data. Component comparisons were made using the Kruskal-Wallis H rank sum test for non-normally distributed quantitative data.

RESULTS:

One-way repeated-measures ANOVA main effect analysis showed different effects of different treatments on PaO2 in patients with COVID-19 (F treatment $=$ 256.231, $P<$ 0.05), with the order of awake prone position group $>$ intubation prone position group $>$ supine position group. The effects of the three different treatments on P/F in patients with COVID-19 (F treatment $=$ 311.661, $P<$ 0.05), with the order of awake prone position group $>$ supine position group $>$ intubation prone position group; Moreover, the three treatments had different effects on APACHE II scores in patients with COVID-19 (F treatment $=$ 201.342, $P<$ 0.05), with the order of intubation prone position group $>$ supine position group $>$ awake prone position group.

CONCLUSION:

Intubation prone position and awake prone position can improve lung function to some extent in patients with COVID-19, and should be applied as early as possible in patients with COVID-19-induced ARDS.