![]() In addition, prone positioning increased the risks of pressure sores and endotracheal tube obstruction ( 9). Prone positioning reduced the mortality rate among the patients who were ventilated for at least 12 hours. In the first week of infection, the patients with moderate to severe ARDS are recommended to receive ventilation in the prone position ( 10). Also, prone positioning reduced 28-d and 90-day mortality rates and extubation time and increased ventilator-free days ( 10). However, numerous randomized trials and meta-analyses have shown that prone position in conjunction with a lung-protective strategy, when performed early and in sufficient duration, may improve survival rate among the patients with ARDS ( 10). It is difficult to predict patients’ response to prone positioning since it has different forms among patients. ARDS and severe hypoxemic patients (Pao2: Fio2 ratio<150 mm Hg, Fio2≥0.6, PEEP≥5 cmH 2O) can benefit from prone positioning if early intervention is performed and the positioning would last in relatively long sessions ( 6). This results in reduction in the difference between dorsal and ventral transpulmonary pressures, reduction in lung compression, and enhancing perfusion ( 9). According to the present theories, prone positioning, by reducing ventral alveolar expansion and dorsal alveolar collapse, results in ventilation that is more homogeneous. In prone position, the central anterior parts are compressed as a result, increasing cardiac output and improving pulmonary respiration are among the advantages of prone positioning ( 8). In supine position, the heart and its adjacent parts likely compress the central posterior parts of the lung. Furthermore, numerous lines of evidence have confirmed that prone positioning could prevent lung injuries caused by ventilators ( 6- 7). It is proven that oxygenation is significantly more beneficial in prone position compared to the supine position. Prone positioning is a conventional method to enhance oxygenation in Acute Respiratory Distress Syndrome (ARDS) patients who need mechanical ventilator ( 6). A study revealed that among the 52 patients with a severe COVID-19 infection, 67% had acute respiratory distress syndrome (ARDS), 63.5%, 42%, and 56% took high-flow nasal cannula (HFNC), invasive mechanical ventilation, and noninvasive mechanical ventilation, respectively ( 5). About 19% of patients infected by COVID-19 suffer from hypoxic respiratory failure, and approximately 14% will develop severe infection, who require oxygen therapy, and 5% will require mechanical ventilation and ICU admission ( 3- 4). Every patient with acute severe respiratory disorder should be managed in the Intensive Care Unit (ICU) based on the recommendation of the Surviving Sepsis Campaign panel ( 2). ![]() COVID-19 is new type of virus that infects respiratory system ( 1).
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