A retrospective study on complications associated with prone positioning during mechanical ventilation in the COVID-19 era

Abstract

Background: Prone ventilation is now widely recommended and implemented for critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite its effectiveness, proning is associated with potential complications. The aim of our study was to describe the range of complications encountered during prone ventilation of adult patients with SARS-CoV-2 and to identify associated risk factors for these complications. Methods: This was a single centre retrospective observational study carried out in the intensive care unit (ICU) in Tallaght University Hospital, an academic tertiary referral hospital, between March and June 2020. We included all adult patients admitted to the ICU with laboratory-confirmed infection with SARS-CoV-2 who were treated with invasive mechanical ventilation and prone positioning on at least one occasion. Our primary analysis was a multivariable Poisson regression model used to evaluate whether predictor variables were independently associated with a significantly increased total number of complications related to proning. Results: A total of 17 patients were eligible for inclusion. The median number of proning sessions per patient was four with a median time of 17 hours. The most common complications noted were skin ulcers in 15/17 (88.2%) patients and neurological complications in 12/17 (70.6%) patients. In a multivariable Poisson regression model, only diabetes mellitus was independently associated with an increased total number of proning complications. Conclusions: In this single centre retrospective observational study, 88% of patients suffered complications associated with prone positioning during their ICU stay with SARS-CoV-2 pneumonitis. Diabetes mellitus was independently associated with a significantly increased total number of proning complications. Adequate staff education and training is essential to ensure that this treatment can be provided safely for those who need it.