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Vol. 70. Issue 2.
Pages 188-190 (01 March 2020)
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Vol. 70. Issue 2.
Pages 188-190 (01 March 2020)
Letter to the Editor
DOI: 10.1016/j.bjane.2020.05.001
Open Access
Prone positioning in management of COVID-19 hospitalized patients
Uso do decúbito ventral para o manejo de pacientes com COVID-19 hospitalizados em enfermaria
Vahid Damanpak Moghadama, Hamed Shafieeb, Maryam Ghorbanic,
Corresponding author

Corresponding author.
, Reza Heidarifarb
a Department of Anesthesiology and Critical Care, Qom University of Medical Sciences, Qom, Iran
b Clinical Research Development Center, Nekouei-Hedayati-Forghani Hospital, Qom University of Medical Sciences, Qom, Iran
c Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Tables (1)
Table 1. Information of patients hospitalized with COVID-19.
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Dear Editor,

Since Zhe Xu, reported a 50 year-old man with confirmed COVID-19 and pathologically Acute Respiratory Distress Syndrome (ARDS),1 the other researchers such as Heymann et al. emphasizes occurrence of ARDS in these patients.2 Many treatments and interventions have been suggested for this syndrome and some of them have been approved. We suggest prone positioning. Some benefits have been stated for this position including: improved ventilation-perfusion matching, recruitment of lung dependent regions, optimized chest wall mechanics, and enhanced drainage of tracheobronchial secretions.3 Besides these declared benefits, there were not any consistent results about the effects of this position in ARDS cases. So Beitler et al. worked on a meta-analysis of seven clinical trials and finally reported that Prone positioning significantly reduces mortality from ARDS in patients with low tidal volume.4

We applied prone position in 10 randomly selected patients, which had COVID-19 (70% male and 30% female) and were hospitalized in a non-ICU ward specific for COVID-19 patients. Tracheal intubation was not applied for any patients. None of them used mechanical ventilation. The mean age of patients was 41 years-old. 30% of them had history of underlying diseases (hypertension or diabetes). We observed that mean SPO2% was 85.6% and 95.9% before and after positioning, respectively, and administrating this position show remarkable change in SPO2%. Also, the feeling of dyspnea decreased to 40% of cases and all patients were discharged from the hospital. Mean hospitalization duration for these patients was 4.8 days and no deaths occurred (Table 1). Written informed consent was obtained from all the participants.

Table 1.

Information of patients hospitalized with COVID-19.

Case  Sex & Age  Tobacco Smoker?  Underlying disease?  Tracheal Intubation  Dyspenea before positioning  Respiratory rate before positioning  SPO2% before positioning  Use of auxiliary breathing muscles before positioning  Dyspenea after positioning  Respiratory rate after positioning  SPO2% after positioning  Use of auxiliary breathing muscles after positioning  Time of hospitalization (days) 
M/31  No  No  No  Yes  22  85  No  No  22  97  No 
M/30  No  No  No  Yes  22  86  No  Yes  22  99  No 
M/41  No  No  Yes  21  85  No  No  22  93  Yes 
M/34  No  No  Yes  21  86  Yes  Yes  22  97  No 
M/34  No  No  No  Yes  19  87  No  No  20  95  No 
M/53  No  No  No  Yes  18  85  Yes  Yes  24  98  No 
M/56  No  No  No  Yes  22  85  No  No  21  94  No 
F/38  No  No  No  Yes  20  86  Yes  Yes  24  93  No 
F/45  No  No  No  Yes  18  86  No  No  21  98  No 
10  F/48  No  No  Yes  27  85  No  No  26  95  Yes 

M, Male; F, Female; H, Hypertension; D, Diabetes.

While our results may not show statistically worth information, we clinically observed improvement in respiration status and SPO2% of patients by applying prone positioning, so it seems that this position can help COVID-19 patients who suffer from a mild form of the disease and reduce mortality. But more precise and valid studies about this protective intervention are needed.

Author's contribution

All authors met the criteria for authorship contribution based on recommendations of the International Committee of Medical Journal Editors.

Conflicts of interest

The authors declare no conflicts of interest.


We would like to thank all the personnel of the ward of COVID-19 infected patients in Forghani Hospital for their cooperation in the performance of this project.

Z. Xu, L. Shi, Y. Wang, et al.
Pathological findings of COVID-19 associated with acute respiratory distress syndrome.
Lancet Respir Med, 8 (2020), pp. 420-422
D.L. Heymann, N. Shindo.
COVID-19: what is next for public health?.
C. Guérin.
Prone position. Acute respiratory distress syndrome.
Springer International Publishing, (2017), pp. 73-83
J.R. Beitler, S. Shaefi, S.B. Montesi, et al.
Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era: a meta-analysis.
Intensive Care Med, 40 (2014), pp. 332-341
Copyright © 2020. Sociedade Brasileira de Anestesiologia
Brazilian Journal of Anesthesiology (English Edition)

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