Prone position as a therapeutic strategy for elderly patients with COVID-19 under mechanical ventilation
DOI:
https://doi.org/10.17267/2317-3378rec.2025.e6153Keywords:
Elderly, COVID-19, Mechanical Ventilation, DeathAbstract
OBJECTIVE: To evaluate the use of the prone position (PP) as a therapeutic strategy for elderly patients diagnosed with COVID-19 undergoing invasive mechanical ventilation (IMV). METHODOLOGY: A cross-sectional descriptive retrospective study was carried out through the analysis of 166 medical records related to the patients' hospitalization in a COVID intensive care unit from April to August 2021 at a large hospital in the Federal District. Data collection included sociodemographic, clinical, and healthcare information, as well as health outcomes. Descriptive statistics were used to characterize the sample, and the Wilcoxon test was used to assess differences before and after the adoption of the PP. RESULTS: A total of 66 elderly patients were hospitalized with a diagnosis of COVID-19 and required IMV. The majority were male (51.5%), had comorbidities such as systemic arterial hypertension (56.1%) and diabetes mellitus (25.8%), and 80.3% of cases were already admitted intubated. The mean duration of IMV use was 10 days (±11.05). PP was used in 10.6% of patients. The most frequent outcome was death (72.7%). Patients undergoing PP showed no statistically significant differences in pulmonary mechanics and oxygenation index before and after PP adoption. CONCLUSION: The use of PP in elderly patients with COVID-19 undergoing IMV was uncommon and showed no significant impact on pulmonary mechanics or improved oxygenation.
Downloads
References
1. Raoof S, Nava S, Carpati C, Hill NS. High-flow, noninvasive ventilation and awake (nonintubation) proning in patients with coronavírus disease 2019 with respiratory failure. Chest. 2020;158(5):1992-2002. https://doi.org/10.1016/j.chest.2020.07.013
2. Nascimento VA, Oliveira JA, Moreira MNG, Oliveira JB, Gonzaga VR, Haddad MF. Características clínicas e efeitos do COVID-19 nos pacientes idosos: uma revisão integrativa. Arch Health Invest. 2020;9(6):617-22. https://doi.org/10.21270/archi.v9i6.5268
3. Pontes L, Danski MTR, Piubello SMN, Pereira JFG, Jantsch LB, Costa LB, et al. Clinical profile and factors associated with the death of COVID-19 patients in the first months of the pandemic. Esc Anna Nery. 2022;26:e20210203. https://doi.org/10.1590/2177-9465-EAN-2021-0203
4. Inoue LH, Baccon WC, Pesce GB, Pereira ND, Silva IVTC, Salci MA, et al. Prevalence and factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná. Rev Esc Enferm USP. 2023;57:e20230036. https://doi.org/10.1590/1980-220X-REEUSP-2023-0036pt
5. Douville NJ, Douville CB, Mentz G, Mathis MR, Pancaro C, Trempler KK, et al. Clinically applicable approach for predicting mechanical ventilation in patients with COVID-19. Br J Anaesth. 2021;126(3):578-89. https://doi.org/10.1016/j.bja.2020.11.034
6. Kharat A, Simon M, Guérin C. Prone position in COVID 19 associated acute respiratory failure. Curr Opin Crit Care. 2022;28:57-65. https://doi.org/10.1097/mcc.0000000000000900
7. Souza FM, Batista J. The perception of nursing students regarding the prone position in patients with COVID-19 J. Health Biol Sci., 2025; 13(1): e5686. https://doi.org/ 10.12662/2317-3076jhbs.v13i1.5686.pe5686.2025
8. Guérin C, Albert RK, Beitler J, Gattinoni L, Jaber S, Marini JJ, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med. 2020;46:2385-96. https://doi.org/10.1007/s00134-020-06306-w
9. Remelli F, Volpato S, Trevisan C. Clinical features of SARS-CoV-2 infection in older adults. Clin Geriatr Med. 2022;38:483-500. https://doi.org/10.1016/j.cger.2022.03.001
10. Lima BDS, Rabito LBF, Yagi MCN, Kreling MCGD, Rocha AF, Karino ME. Clinical-epidemiological profile of patients with covid-19 admitted to a university hospital reference. Enferm Glob. 2023;22(2):257-96. https://dx.doi.org/10.6018/eglobal.544171
11. Yano EMSM, Romero JF, Amaral MP, Soares SD. Perfil epidemiológico dos idosos com COVID-19 no estado do Ceará no período de janeiro de 2020 até julho de 2022. Braz J Infect Dis. 2023;27(S1):102812. https://doi.org/10.1016/j.bjid.2023.102940
12. Wang X, Hu J, Wu D. Risk factors for frailty in older adults. Medicine (Baltimore). 2022;101(34):e30169. https://doi.org/10.1097/md.0000000000030169
13. Guimarães AM, Reis LA, Oliveira AS, Lopes AOS. Epidemiological profile of elderly affected by covid-19. Saud Coletiv (Barueri). 2023;13(86):12681-8. https://doi.org/10.36489/saudecoletiva.2023v13i86p12681-12688
14. Cronin JN, Camporota L, Formenti F. Mechanical ventilation in COVID-19: a physiological perspective. Exp Physiol. 2022;107(7):683-93. https://doi.org/10.1113/ep089400
15. Pires PHC, Nascimento BC, Santos AS, Pereira JS, Silva GP, Bomfim TL, et al. Práticas efetivas para prevenção da pneumonia associada à ventilação mecânica: uma revisão integrativa. Braz J Implantol Health Sci. 2024;6(12):2093-2106. https://doi.org/10.36557/2674-8169.2024v6n12p2093-2106
16. Cruz DA, Sousa IL, Santana PVD, Oliveira LKA, Sousa FWS, Araújo AMX, et al. Impacts of invasive mechanical ventilation on patients from COVID-19: integrative review. Res Soc Dev. 2021;11(11):e380101119656. https://doi.org/10.33448/rsd-v10i11.19656
17. Cunha MCA, Schardonga J, Righi NC, Lunardi AC, Sant’Anna GN, Isensee LP, et al. Impact of prone positioning on patients with COVID-19 and ARDS on invasive mechanical ventilation: a multicenter cohort study. J Bras Pneumol. 2022;48(2):e20210374. https://doi.org/10.36416/1806-3756/e20210374
18. Chua EX, Zahir SMISM, Ng KT, Teoh WY, Hasan MS, Manaes SRBR, et al. Effect of prone versus supine position in COVID-19 patients: a systematic review and meta-analysis. J Clin Anesth. 2021;74:110406. https://doi.org/10.1016/j.jclinane.2021.110406
19. Mello GA, Oliveira AEC, Brugger EBA. Efetividade da posição prona em pacientes com COVID-19 internados em uma unidade de terapia intensiva. Braz J Develop. 2024;10(12):1-11. https://doi.org/10.34117/bjdv10n12-006
20. Fossali T, Pavlovsky B, Ottolina D, Colombo R, Basile MC, Castelli A, et al. Effects of prone position on lung recruitment and ventilation-perfusion matching in patients with COVID-19 acute respiratory distress syndrome: a combined CT scan/ electrical impedance tomography study. Crit Care Med. 2022;50(5):723-32. https://doi.org/10.1097/ccm.0000000000005450
21. Araújo MS, Santos MMP, Silva CJA, Menezes RMP, Feijão AR, Medeiros SM. Prone positioning as an emerging tool in the care provided to patients infected with COVID-19: a scoping review. Rev Latino-Am Enfermagem, 2021;29:e3397. https://doi.org/10.1590/1518-8345.4732.3397
22. Dilken O, Rezoagli E, Dumanli GY, Ürkmez S, Demirkiran O, Dikmen Y. Effect of prone positioning on end-expiratory lung volume, strain and oxygenation change over time in COVID-19 acute respiratory distress syndrome: a prospective physiological study. Front Med. 2022;9:1056766. https://doi.org/10.3389/fmed.2022.1056766
23. Dorado JH, Navarro E, Plotnikow GA, Gogniat E, Accoce M. Epidemiology of weaning from invasive mechanical ventilation in subjects with COVID-19. Respir Care. 2023;68(1):101-9. https://doi.org/10.4187/respcare.09925
24. Roso LH, Carvalho SM, Maurer TC, Rossi D, Camillis MLF, Garcia LMC. Clinical profile and outcomes of patients hospitalized for COVID-19 in a hospital in southern Brazil. Rev. Baiana Enferm. 2022;36:e45838. https://doi.org/10.18471/rbe.v36.45838
25. Corrêa TD, Midega TD, Timenetsky KT, Cordioli RL, Barbas CSV, Silva Júnior M, et al. Clinical characteristics and outcomes of COVID-19 patients admitted to the intensive care unit during the first year of the pandemic in Brazil: a single center retrospective cohort study. Einstein. 2021;19:eAO6739. https://doi.org/10.31744/einstein_journal/2021AO6739
26. Escorcio R, Paiva F, Guedes E, Mendes LF, Burti JS. Prone position in intubated patients with acute respiratory failure due to COVID-19 in an ICU in the state of São Paulo. Fisioter Mov. 2014;37:e37118.0. https://doi.org/10.1590/fm.2024.37118.0
27. Zanchetta FC, Silva JLG, Pedrosa RBS, Kumakura ARS, Gasparino RC, Perissoto S, et al. Nursing care and prone position: Integrative review. Av Enferm. 2022;40(1suppl):37-51. http://doi.org/10.15446/av.enferm.v40n1supl.91372
28. Costa GS, Mendes CP, Vetorazo JVP, Costa TS. Impact of the prone position in the clinic of patients with COVID-19 and the role of nursing. REAS. 2024;24(12):e17236. https://doi.org/10.25248/reas.e17236.2024
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Thalita Cristinny Araujo Silva, Alexandra Mailane Marques Miranda, Luan Nascimento Silva, Mara Dayanne Alves Ribeiro, Sabrynna Brito Oliveira, Jefferson Carlos Araujo Silva
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License.
