Haemodynamic changes during prone versus supine position in patients with COVID-19 acute respiratory distress syndrome.
Madeline Coxwell Matthewman, Fumitaka Yanase, Rahul Costa-Pinto and 7 others
PMID 37160405WHAT IT FOUND
In 18 ventilated patients with COVID-19 ARDS, turning prone was associated with higher cardiac index and better oxygenation.
Oxygen delivery also rose, but this small before-and-after study does not prove prone positioning improves survival.
Key findings
01Cardiac index was higher in the prone position than in the supine position, with a mean difference of 0.44 L/min/m2.
02After 12 to 18 hours of prone positioning, median FiO2 fell from 55% to 35%, and median P/F ratio rose from 120 to 220 mm Hg.
03Oxygen delivery increased from a median of 597 ml O2/min in the supine position to 743 ml O2/min in the prone position.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Only 18 patients were studied, all from one Australian ICU. Patients were selected by availability of FloTrac monitors, so not every prone patient could be included. The study compared the same patients before and after prone positioning, so it cannot prove that prone positioning caused the changes. Patients were already receiving mechanical ventilation, propofol, fentanyl, midazolam, cisatracurium, dexamethasone, and sometimes noradrenaline, milrinone, remdesivir, tocilizumab, baricitinib or inhaled nitric oxide, so the contribution of any single component cannot be separated. Haemodynamic measurements were taken for only 4 hours around the prone session, so longer-term effects were not assessed. FloTrac may be less reliable than other cardiac output methods, although the study compared changes within the same device in the same patients.
Declared interests
No specific grant was received from public, commercial or not-for-profit sectors, and all authors declared no conflicts of interest.
The easy way to misread this
Do not read the higher cardiac index as proof that prone positioning improves survival. This was a small before-and-after study of 18 patients, and they were already receiving mechanical ventilation, propofol, fentanyl, midazolam, cisatracurium, dexamethasone, and sometimes noradrenaline, milrinone, remdesivir, tocilizumab, baricitinib or inhaled nitric oxide, so the change cannot be separated from those ongoing therapies.