Hemodynamic Effects of Awake Prone Positioning With COVID-19 Acute Respiratory Failure

INTRODUCTION: Awake prone positioning (PP) reduces need for intubation for patients with COVID-19 with acute respiratory failure. We investigated the hemodynamic effects of awake PP in non-ventilated subjects with COVID-19 acute respiratory failure. METHODS: We conducted a single-center prospective cohort study. Adult hypoxemic subjects with COVID-19 not requiring invasive mechanical ventilation receiving at least one PP session were included. Hemodynamic assessment was done with transthoracic echocardiography before, during, and after a PP session. RESULTS: Twenty-six subjects were included. We observed a significant and reversible increase in cardiac index (CI) during PP compared to supine position (SP): 3.0 6 0.8 L/min/m(2) in PP, 2.5 6 0.6 L/min/m2 before PP (SP1), and 2.6 6 0.5 L/min/m(2) after PP (SP2, P <.001). A significant improvement in right ventricular (RV) systolic function was also evidenced during PP: The RV fractional area change was 36 6 10% in SP1, 46 6 10% during PP, and 35 6 8% in SP2 (P <.001). There was no significant difference in PaO2/FIO2 and breathing frequency. CONCLUSION: CI and RV systolic function are improved by awake PP in non-ventilated subjects with COVID-19 with acute respiratory failure.