Profile of Patients Responding to Positive End-Expiratory Pressure and Prone Position during ARDS Related to COVID-19: A Case of the Sens Hospital

Background: There is a paucity of data on the efficacy of ventilatory strategies in COVID-19-related ARDS. The aim of this study was to describe the effect of positive end-expiratory pressure (PEEP) and prone position (PP) on oxygenation and determine the profile of responders. Methods: This was a cross-sectional study of patients admitted to the intensive care unit of the Sens Hospital with COVID-19-related ARDS who were invasively ventilated for more than 24 hours between 1 March 2020 and 2 March 2021. A good oxygenation response to PEEP and/or PP was defined as an increase in the PaO2/FiO2 ratio (pre-post) of more than 20% within 4 hours after the application of these measures. Results: Forty patients were recruited, 28 of whom were men. Standard ventilation allowed us to observe 3 subgroups of patients: 5 (12.5%) requiring protective ventilation with a PEP ≤ 8 cmH2O, 5 (12.5%) requiring protective ventilation with a PEEP > 8 cmH2O, and finally 30 (75%) requiring protective ventilation with a PEEP > 8 cmH2O combined with PP sessions. Almost all (80%) of the patients (the majority of whom were obese) placed on PP with PEP > 8 cmH2O had a good response to oxygenation. No characteristic was associated with non-response. Conclusion: The use of PEEP and the use of prone position increased the PaO2/FiO2 ratio in the vast majority of patients, particularly those who were obese. No characteristic was associated with non-response, so prone position can be offered to those with the indication. A high-powered study is needed to confirm this profile and assess the benefit of PP on mortality.