Cardiorespiratory Physiotherapy, Critical Care and Rehabilitation
Cardiorespiratory Physiotherapy, Critical Care and Rehabilitation
Original Research

Characterization of patients with COVID-19-related ARDS before the prone position: prospective cohort study

Giovani Bernardo Costa; Higor Apolinario Melquiades; Erich Vidal Carvalho; Edimar Pedrosa Gomes; Maycon Moura Reboredo; Bruno Valle Pinheiro

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Background: The general characteristics and ventilator-related variables of patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 infection who have undergone invasive mechanical ventilation (MV) remain unclear, especially those who need a prone position (PP). Aim: To characterize the clinical, demographical, and ventilatory variables of patients on MV with COVID-19-related ARDS, evolving to PP. Methods: This study was an observational prospective cohort investigation of COVID-19 patients undergoing invasive MV. PP and non-prone groups were compared using Student’s t, Mann-Whitney U, chi-square, or Fisher’s exact tests. Binary logistic regression was used to identify predictor variables. Statistical significance was set at p < 0.05. The study design was approved by the Research Ethics Committee. Results: The clinical and demographical characteristics of patients requiring PP were: age (63.4 ± 12.4 years), predicted body weight (57.3 ± 11.0 kg), SAPS 3 47.5 (41-55), SOFA 3 (2-6), comorbidities, days until intubation (1.2 ± 2.2 days), and death in the ICU (52.4%); these characteristics were similar to those who remained in supine position. A total of 42 (65.6%) subjects needed PP, especially females. There were no differences between PP and non-prone groups in respiratory system compliance (Crs) [(30.0 (24.6-35.3)], driving pressure (ΔP) (14.2 ± 3.9 cm H2O) and plateau pressure (Pplateau) (23.9 ± 4.7 cmH2O). The PP group had lower initial PaO2/FIO2 ratio values (130.5 ± 58.1 vs 187.5 ± 59.1, p < 0,05). Crs was not a significant predictor of PP (OR 1.702; CI 95% 0.962 – 1.131). Conclusions: Most patients required PP, especially females aged over 60. These patients frequently use neuromuscular blockers and had a longer hospital stay. Upon admission to the ICU, the Crs, Pplateau, and ΔP values of these patients were similar to those who did not require PP; PaO2/FiO2 ratio characterized patients who needed PP.


COVID-19; SARS-CoV-2; Artificial Respiration; Prone Position; Respiratory Distress Syndrome.


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