Early Prone Position in Conscious Patients with COVID-19 Pneumonia and Acute Respiratory Insufficiency: What have we learned?

Abstract

The beta coronavirus Sars-CoV2 pandemic, initiated in December 2019, has infected millions of people until today and caused many individuals to die. The main reason for morbidity and mortality impact is the development in the affected people of bilateral pneumonia, progressing frequently to severe acute hypoxemic respiratory insufficiency, requiring supplementary oxygen therapy or mechanically assisted ventilation. It has been demonstrated that using prone positioning in patients on mechanical ventilation reduces mortality. In COVID-19 pneumonia, using the strategy of prone position in awake patients with hypoxemia, showed immediate improvements on that condition and delayed the need of endotracheal intubation and derivation to the ICU. This review describes pathophysiological mechanisms, processes of implementation, available evidence, morbimortality impact and the experience about this intervention at a public hospital located in Buenos Aires Autonomous City, Argentina, related to the management of a large amount of patients assisted since the beginning of year 2020 to September 2021.