Prone to recovery- evaluating the effectiveness of positional therapy in managing covid-19 respiratory distress

Abstract

This thesis analyzes the clinical effectiveness of prone positioning used as a form of positional therapy in managing acute respiratory distress syndrome (ARDS) among COVID-19 patients. The emphasis was undertaken in order to ascertain the patient characteristics affecting outcomes based on timing and duration of treatment. The work further evaluates prone positioning against various interventions such as high-flow nasal oxygen (HFNO) and Extracorporeal membrane oxygenation (ECMO). This study addresses a critical clinical gap in managing patients with COVID-19- induced ARDS, particularly in low-resource settings where invasive ventilation or ECMO may not be readily available. By focusing on the practical application and measurable outcomes of prone positioning in combination with non-invasive therapies that can guide front-line decision-making and optimize patient care during public health crises. Study Purpose: to study the huge demand on healthcare systems triggered by the COVID-19 pandemic that brought about the need for design and provision of inexpensive and scalable solutions for managing severe respiratory distress. Objectives: 1) To what extent does prone positioning help COVID-19 patients' respiratory function. 2) To evaluate whether prone positioning can diminish reliance on invasive mechanical ventilation when compared to HFNO and ECMO. 3) To examine the impact of early and consistent implementation of prone positioning on patient mortality. 4) To Analyze how patient-specific factors, such as BMI and comorbidities, influence the outcomes of prone positioning. 5) To assess the clinical utility of prone positioning as a cost-effective, non-resource healthcare settings. Object of the Research: to assess the clinical effectiveness of application of prone positioning in improving outcomes for patients with ARDS in COVID-19. Subject of the Research: Hospitalized patients diagnosed with intubated and non-intubated patients with COVID-19 who received prone positioning therapy within hospital settings [2]. Methods: A systematic review approach was employed, subjecting peer-reviewed studies from 2019-2024 to selection, accessed primarily through PubMed, Scopus, and Cochrane Library databases. Inclusion criteria were diseases with adult COVID-19 patients who were treated with prone positioning while exclusion criteria focused on studies with insufficient data on outcomes or incompatibility in methodology. The scientific and practical value of the study: The data were analyzed using descriptive statistics, comparative outcome metrics, and, whenever possible, meta-analysis. As results indicate, prone positioning produces better oxygenation and thwarts intubation, especially in those non-intubated cases with moderate respiratory failure. However, its efficacy is modulated by age, BMI, comorbidities, and the intervention's timing. Complications such as pressure ulcers, nerve injuries, etc., warrant stringent patient monitoring and protocol optimization. The study concludes that prone positioning presents a realistic and inexpensive option suitable for a resource-constrained setting and recommends that further studies be initiated on its long-term effect and would framework for its standardized implementation. Obtained Results: Prone positioning improved oxygenation in most patients and reduced the need for intubation. The effect was stronger in patients with moderate respiratory distress. Patient age, BMI, and comorbidities influenced the outcomes. Only minor complications were reported. Conclusions: the findings support the use of prone positioning as an effective, low-cost treatment for COVID-19-related respiratory distress, especially in settings with limited resources.