Hemodynamic Effects of Awake Prone Positioning With COVID-19 Acute Respiratory Failure

Awake prone positioning (PP) reduces need for intubation for patients with COVID-19 with acute respiratory failure. We investigated the hemodynamic effects of awake PP in non-ventilated subjects with COVID-19 acute respiratory failure. We conducted a single-center prospective cohort study. Adult hypoxemic subjects with COVID-19 not requiring invasive mechanical ventilation receiving at least one PP session were included. Hemodynamic assessment was done with transthoracic echocardiography before, during, and after a PP session. Twenty-six subjects were included. We observed a significant and reversible increase in cardiac index (CI) during PP compared to supine position (SP): 3.0 ± 0.8 L/min/m in PP, 2.5 ± 0.6 L/min/m before PP (SP1), and 2.6 ± 0.5 L/min/m after PP (SP2 < .001). A significant improvement in right ventricular (RV) systolic function was also evidenced during PP: The RV fractional area change was 36 ± 10% in SP1, 46 ± 10% during PP, and 35 ± 8% in SP2 ( < .001). There was no significant difference in P /F and breathing frequency. CI and RV systolic function are improved by awake PP in non-ventilated subjects with COVID-19 with acute respiratory failure.