Is prolonged period of prone position effective and safe in mechanically ventilated patients with SARS-CoV-2? A randomized clinical trial

Background The novel coronavirus has been recently spreading throughout the world, causing severe acute respiratory syndrome (SARS-CoV-2) that necessitates mechanical ventilation. Prone position ventilation is an established method to improve oxygenation in severe acute respiratory distress syndrome (ARDS). Different protocols were suggested and evaluated for prone position (PP) cycles duration. We performed a randomized controlled study to compare the standard 16 h prone ventilation against extended 24 h prone ventilation in terms of safety and efficacy. Methods A total of 52 patients were divided into two groups. Group (A) proning cycles that lasted for 16 h every 24 h, Group (B): prolonged proning cycles that lasted for continuous 24 h followed by 6 h supine position. Both groups received lung-protective ventilation, arterial blood gases were sampled, static lung compliance was measured before proning and one hour after return to supine position. After three successive cycles, the mean value was measured and recorded. Results We found that extending the duration of prone position (PP) sessions from 16 h to 24 h was associated with a significant improvement in PaO2/FiO(2), significant elevation in static lung compliance and non-significant changes in the rate of extubation. 24 h PP was proven to be safe, with no significant elevation in the rate of complications, and nearly the same impact on survival and length of hospital stay. Conclusion Extending PP ventilation to 24 h for COVID-19 ARDS patients is safe and effective. Trial registration: the trial w registered on November 2021 in ClinicalTrials.gov (CT05109624).