Hemodynamic Effects of Awake Prone Positioning With COVID-19 Acute Respiratory Failure

Respir Care. 2023 Jun;68(6):713-720. doi: 10.4187/respcare.10597.

Abstract

Introduction: Awake prone positioning (PP) reduces need for intubation for patients with COVID-19 with acute respiratory failure. We investigated the hemodynamic effects of awake PP in non-ventilated subjects with COVID-19 acute respiratory failure.

Methods: We conducted a single-center prospective cohort study. Adult hypoxemic subjects with COVID-19 not requiring invasive mechanical ventilation receiving at least one PP session were included. Hemodynamic assessment was done with transthoracic echocardiography before, during, and after a PP session.

Results: Twenty-six subjects were included. We observed a significant and reversible increase in cardiac index (CI) during PP compared to supine position (SP): 3.0 ± 0.8 L/min/m2 in PP, 2.5 ± 0.6 L/min/m2 before PP (SP1), and 2.6 ± 0.5 L/min/m2 after PP (SP2, P < .001). A significant improvement in right ventricular (RV) systolic function was also evidenced during PP: The RV fractional area change was 36 ± 10% in SP1, 46 ± 10% during PP, and 35 ± 8% in SP2 (P < .001). There was no significant difference in PaO2 /FIO2 and breathing frequency.

Conclusion: CI and RV systolic function are improved by awake PP in non-ventilated subjects with COVID-19 with acute respiratory failure.

Keywords: ARDS; COVID-19; awake prone position; cardiac index; echocardiography; hemodynamic.

MeSH terms

  • Adult
  • COVID-19* / complications
  • COVID-19* / therapy
  • Hemodynamics
  • Humans
  • Prone Position
  • Prospective Studies
  • Respiratory Distress Syndrome*
  • Respiratory Insufficiency* / etiology
  • Respiratory Insufficiency* / therapy
  • Wakefulness