INTRODUCTION: Prone positioning is a cornerstone therapy in COVID-19 associated severe Acute Respiratory Distress Syndrome (ARDS) Ventilatory ratio (VR) calculates dead space ventilation, which is independently associated with an increased risk of mortality in ARDS patients However, no studies so far have demonstrated the changes in VR with proning in such patients We evaluated VR as a new tool to predict survival in prone positioned COVID -19 ARDS patients METHODS: This retrospective study included 24 COVID-19 positive ARDS patients admitted to SUNY Downstate Medical Center ICU between April 4, 2020 to May 15, 2020, who had PaO2/FiO2 (PF) ratio 2 The mortality rate for all patients included was 80% (20/24) CONCLUSIONS: COVID -19 ARDS patients demonstrate impaired ventilation and hypoxemia Commonly used PF ratio, in proning protocols, has limited prognostic value but deadspace fraction is a powerful predictor of mortality in ARDS Proning improved PF ratio and VR, however, the latter did not reach statistical significance PF ratio was not predictive of length of survival, however, VR &gt; 2 before proning is a significant predictor for overall mortality Hence, VR can function as a new bedside predictive tool with proning in COVID-19 ARDS patients
Ventilatory ratio with proning in COVID-19 ards patients: A new tool for an old strategy