Manual proning of a morbidly obese COVID-19 patient: A case report.
Erika Salciute-Simene
PMID 34782246WHAT IT FOUND
Oxygenation improved after 16 hours in one intubated morbidly obese patient during a complex ICU course including proning, ventilation, noradrenaline, renal replacement and thrombolysis; he died, and this single case cannot show proning worked.
Key findings
01After a 16-hour proning session, SpO2 was 91% and PaO2 67 mmHg on FiO2 0.6 in a patient who had also received CPAP, intubation, chest compressions, thrombolysis, noradrenaline infusion and renal replacement therapy.
02The described technique used three sheets, four friction-reducing sheets and four to six pillows, with stated goals of avoiding lifting, straightening the body and using pillows for thoracopelvic support.
03The proning team reported no injuries, and time to prone shortened from approximately 1 hour to 30 min, but the patient died after 9 days of ICU stay.
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What it does not show
It is a single case report, so it cannot show that the technique works or is safe for other patients. The patient received CPAP, intubation, chest compressions, thrombolysis, noradrenaline infusion and renal replacement therapy along with proning, so improvement cannot be assigned to proning alone. The patient was a 50-year-old man with BMI 51, asthma, obstructive sleep apnoea, shock and acute kidney injury, so the approach may not apply to other body sizes, oxygen needs or ICU staffing. Staff safety was based on the proning team reporting no injuries, not a formal audit or comparison with lifting aids. The patient died after 9 days, so the case does not show that proning changed survival.
The easy way to misread this
Do not conclude that manual proning without lifting aids is safe or effective for other morbidly obese patients. This is one case; the patient had many concurrent treatments and died, and staff injury safety was only reported by the team.