Brief Communications
Vol. 1 No. 1 (2023)
https://doi.org/10.4081/aapm.9.

Efficacy of repeated pronations in patients affected by COVID-19-related acute respiratory distress syndrome: think it twice!

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Received: 3 March 2023
Accepted: 24 March 2023
Published: 5 August 2025
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COVID-19, pronation, pulmonary shunt, ventilation/perfusion mismatch, ARDS, CARDS

Authors

Andrea Sica
andrea.sica@auslromagna.it
Anesthesia and Intensive Care Unit, Bufalini Hospital, Cesena, Italy.
Luca Gobbi
Anesthesia and Intensive Care Unit, Bufalini Hospital, Cesena, Italy.
Daniele Bellantonio
Anesthesia and Intensive Care Unit, Bufalini Hospital, Cesena, Italy.
Silvia Passero
Anesthesia and Intensive Care Unit, Bufalini Hospital, Cesena, Italy.
Lorenzo Viola
Anesthesia and Intensive Care Unit, Bufalini Hospital, Cesena, Italy.

Prone position is widely used to ameliorate gas exchange in severe COVID-19-related ARDS (CARDS), through its beneficial effects on shunt and dead space. However, the effectiveness of repeated pronation has never been explored in this category of patients. We then retrospectively analyzed the changes of the alveolar-arterial oxygen gradient (A-aO2grad), as shunt index, and the ratio EtCO2/paCO2 ratio, as dead space index, during repeated pronation cycles in 7 patients with CARDS admitted to our Intensive Care Unit. The A-aO2grad decreased significantly more during the first pronation than the second (-43.6% vs. -12.2% - p0.008) and, similarly, the improvement was maintained only after the first supination (-26.2% vs. +9% - p0.04). The EtCO2/paCO2 ratio showed similar behavior but did not achieve statistical significance. Considering our findings, with the inherent limitations of the study, since pronation entails risks for the patient, as well as requiring a lot of effort from the nursing staff, further caution appears to be necessary in indicating pronation.

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How to Cite



Efficacy of repeated pronations in patients affected by COVID-19-related acute respiratory distress syndrome: think it twice!. (2025). Advances in Anesthesia and Pain Medicine, 1(1). https://doi.org/10.4081/aapm.9.
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