Evaluation of the efficiency and complications of the consecutive proning in COVID-19 ICU: a retrospective study

PURPOSE: We aimed to evaluate and compare the efficacy and complications of three consecutive prone positions (PP) in COVID-19 ICU. MATERIALS AND METHOD: Patients with ARDS and placed in PP for 3 times (PP1, PP2, PP3) consecutively were included. Arterial blood gases (ABG), partial pressure of arterial oxygen/fraction of inspired oxygen (PaO(2)/FiO(2)) ratios, partial pressure of carbondioxide (PaCO(2)), PEEP, and FiO(2) were recorded before (bPP), during (dPP), and after (aPP) every prone positioning. Eye, skin, nerve, and tube complications related to PP were collected. RESULTS: In all positions, PaO(2) value during PP was significantly higher than PaO(2) before and after prone position (p = 0.001). PaO(2) values were similar in all (PP1, PP2, PP3) bPP arterial blood gases. We found difference in PaO(2) values during prone position between the first (PP1) and second proning (PP2). When each prone was evaluated within itself, PaO(2)/FiO(2) increases after proning compared to before proning. PaO(2)/FiO(2) during PP were higher compared to before proning ones. PaO(2)/FiO(2) during PP1 was significantly higher compared to during PP3 (p = 0.005). In PP3, PEEP values bPP, dPP, and aPP were significantly higher than PEEP values after the second prone (p = 0.02, p = 0.001, p = 0.01). In the third prone, PaCO(2) levels were higher than in PP1 and PP2. There were eye complications in 13, tube-related complications in 10, skin complications in 30, and nerve damage in 1 patient. CONCLUSION: We believe that a more careful decision should be made after the second prone position in patients who have to be placed in sequential prone position.