Adverse Events during Prone Positioning of Patients with COVID-19 during a Surge in Hospitalizations—Results of an Observational Study

TL;DR

This study found that prone positioning in hospitalized COVID-19 patients was linked to many adverse events, including pressure ulcers and tube removals, with body weight and positioning duration as key factors.

Contribution

The study identifies body weight and prone positioning duration as risk factors for adverse events during a hospital surge, highlighting challenges in critical care during pandemics.

Findings

118 catheter and tube removals occurred in 66 out of 100 patients during prone positioning.

184 pressure ulcers were observed in 79 patients, most commonly on the anterior face and thorax.

Body weight and cumulative prone positioning duration were independently associated with adverse events.

Abstract

This study aimed to determine the prevalence of adverse events in mechanically ventilated adults with COVID-19 who have undergone prone positioning. A total of 100 patients were included retrospectively; 60% were males, the mean age was 64.8 ± 9.1 years, and hospital mortality was 47%. In all, we recorded 118 removals of catheters and tubes in 66 patients; 29.6% were removals of a nasogastric tube, 18.6% of an arterial line, 14.4% of a urinary catheter, and 12.7% of a central venous catheter. Reintubation or repositioning of a tracheotomy tube was required in 19 patients (16.1%), and cardiopulmonary resuscitation in 2 patients (1.7%). We recorded a total of 184 pressure ulcers in 79 patients (on anterior face in 38.5%, anterior thorax in 23.3% and any extremity anteriorly in 15.2%). We observed that body weight (p = 0.021; β = 0.09 (CI95: 0.01–0.17)) and the cumulative duration of prone positioning (p = 0.005; β = 0.06 (CI95: 0.02–0.11)) were independently associated with the occurrence of any adverse event. The use of prone positioning in our setting was associated with a greater number of adverse events than previously reported. Body weight and cumulative duration of prone positioning were associated with the occurrence of adverse events; however, other factors during a COVID-19 surge, such as working conditions, staffing, and staff education, could also have contributed to a high prevalence of adverse events.

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