Physiological Changes During Prone Positioning in COVID-19 Acute Respiratory Distress Syndrome

Dear Editor,Prone positioning is an established treatment modality in acute respiratory distress syndrome (ARDS) and has been employed in the management of ARDS in severe 2019 novel coronavirus disease (COVID-19) in the intensive care unit (ICU) with varying clinical and physiological responses.1,2 To date, Singapore has seen 44,122 COVID-19 patients, with the majority of inpatients managed at National Centre of Infectious Diseases (NCID).NCID ICU has managed 36 mechanically intubated patients thus far.We retrospectively examine the first 20 patients in NCID ICU and describe our early experience of prone positioning in COVID-19 ARDS including identifying potential early physiological indicators of poor response to prone positioning. MethodWe retrospectively reviewed the medical records of all individuals with COVID-19 ARDS who received prone positioning at the NCID from 8 February to 29 March 2020.Since the first reported case of COVID-19 in Singapore on 23 January 2020 to the time of writing, NCID ICU has managed 20 mechanically intubated patients.Baseline clinical characteristics and important physiological indicators during the first prone positioning episode were examined.Physiological indices at various time points were compared using the Wilcoxon matched-pair signed rank tests.P-value of <0.05 was considered statistically significant.Ethical and institutional board review were waived due to provision under the Infectious Diseases Act, Singapore.