key: cord-263572-h7ya60k5
authors: Taboada, Manuel; Bermúdez, Anaberta; Pérez, María; Campaña, Olga
title: Supine versus Prone Positioning in COVID-19 Pneumonia: Comment
date: 2020-08-17
journal: Anesthesiology
DOI: 10.1097/aln.0000000000003511
sha: 
doc_id: 263572
cord_uid: h7ya60k5

nan

To the Editor: P rone positioning is a simple method to improve oxygenation in ventilated patients with acute respiratory distress syndrome (ARDS). 1 Potential explanations are reduction of ventilation/perfusion mismatch, a more homogeneous distribution of transpulmonary pressure along the ventral-to-dorsal axis, and recruitment of nonaerated dorsal lung regions of the lung, with an increase in lung volume. 2 Many of these mechanisms could also apply to awake patients with ARDS by COVID-19. 3 Here, we present an image ( fig. 1 ) from a computed tomography performed in a 71-yr-old woman with ARDS from COVID-19 in both supine and prone positioning during awake spontaneous ventilation. Arterial blood gas analysis in the supine position with high-flow nasal cannula oxygen therapy (50% concentration; flow rate, 50 l/min) showed Pao 2 /fractional inspired oxygen tension (Fio 2 ) of 130, with an improvement in prone positioning (Pao 2 /Fio 2 , 238). Bilateral, multifocal, and asymmetric lung disease was present in the supine computed tomography, with a "crazy paving" pattern (ground-glass opacities associated with smooth interlobular thickening) in the upper lobes, and peripheral, heterogeneous, and ill-defined consolidations in the lower lobes. An increase in total lung volume, mainly due to a significant expansion of both lower lobes ( fig. 1, black arrows) , 

was detected in the prone position (2,749 ± 31 ml) compared to supine (2,418 ± 30 ml). This change was accompanied by a moderate decrease in the attenuation of the lesions in the lower lobes ( fig. 1, blue arrows) , the vast majority showing a ground glass attenuation. These findings support the hypothesis of functional lung tissue recruitment in the prone position in awake patients with ARDS by COVID-19.

PROSEVA Study Group: Prone positioning in severe acute respiratory distress syndrome

Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review

Use of prone positioning in nonintubated patients with COVID-19 and hypoxemic acute respiratory failure

The authors declare no competing interests.