# 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.

## Key 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.