Prone position in intubated patients with acute respiratory failure due to COVID-19 in an ICU in the state of São Paulo

Abstract

Introduction: The severity of acute respiratory distress syndrome (ARDS) caused by COVID-19 can vary and be influenced by comorbidities. The position is a treatment strategy for critically ill patients; however, it is unclear what the physiological response is and which patients benefit. Objective: To determine whether the prone position (PP) and the length of stay in the intensive care unit (ICU) are associated with the time of orotracheal intubation (OTI) and with the death rate in patients on mechanical ventilation with moderate to severe ARDS. Methods: An observational, longitudinal, retrospective study was carried out in a tertiary public hospital in the city of São Paulo. Data were collected from the medical records of all patients diagnosed with COVID-19, with a positive PCR, admitted to the ICU and intubated, from April 2020 to July 2021. Pearson's chi-square and Fischer's exact tests were used to compare sample data, and distributions in the two groups were compared using the Mann-Whitney test. Results: There was no statistically significant difference for ICU length of stay, OTI time and death rate between patients who were prone versus non-prone [13 (4.0 – 23.0) vs. 13.5 (7.2 – 17.0), p = 0.453; 12 (3.0 – 13.0) vs. 10 (6.0 -15.5), p = 0.772; 71 vs. 68%, p = 0.817, respectively]. Conclusion: This study did not demonstrate an association between PP and days of OTI, days of hospitalization and mortality in patients with severe hypoxemia.