According to the statistics provided by the World Health Organization (2021), from the beginning of the pandemic to February 19, 2021, 109,997,288 cases of COVID-19 have been confirmed, including more than 2,430,000 fatal outcomes. Besides, it could be noted that globally there is a trend towards the increase in the number of contaminations with coronavirus. Despite the fact that several countries have already developed effective vaccines that would help stop the spread of the virus and cease the pandemic, many people still daily get to hospitals and require resuscitation.
COVID-19 causes lesions of the lungs and, therefore, leads to respiratory distress. The inpatients with respiratory insufficiency are cured with respiratory therapy. One of the variants of this therapy is artificial pulmonary ventilation. Although ventilation maximizes the chances of inpatients with coronavirus for survival, it remains unclear whether a lying prone increases the efficiency of artificial pulmonary ventilation in comparison with a not lying prone. This uncertainty is the basis of the clinical foreground question that sounds as follows: In adult inpatients with COVID, how effective is lying prone compared to not lying prone for improved ventilation during a hospital admission?
Opportunity for Improving Health Outcomes
The previously outlined question is directly related to the quality of health outcomes because the position during the ventilation affects the expansion of dorsal lung regions and removal of secretions, and, consequently, oxygenation and mortality. The study conducted by Henderson et al. (2014) shows that prone positioning is optimal for patients with acute respiratory distress syndrome (ARDS) because it improves ventilation “due to changes in pleural pressure (PPL) and the amount of lung atelectasis present” (p. 213). Since COVID-19 affects the lungs and, hence, causes ARDS, it could be inferred that adult inpatients with COVID should be in prone positioning during the ventilation.
Khan et al. (2020) and Qadri et al. (2020) agree with the views expressed in the previously mentioned scholarly article. Authors conclude that lying prone could be used as a supportive treatment that relieves ARDS symptoms caused by COVID-19 (Khan et al., 2020; Qadri et al., 2020). The conclusions formulated by Qadri et al. (2020) are based upon the analysis of seven studies that investigated more than 1800 patients in total. The analysis of these research papers enabled Qadri et al. (2020) to claim that prone position leads to significant improvements not only in oxygenation but also in lung recruitment.
At this point, it is interesting to note that lying with the chest down is beneficial for COVID-19 patients, not only during ventilations. According to Chad and Sampson (2020), a prone position “may improve oxygenation in the short term and defer or prevent the need for intubation” for non-ventilated patients with coronavirus (p. e97). Khan et al. (2020), as well as Chad and Sampson (2020), emphasize that lying prone is useful even for patients whose condition does not require ventilation of the lungs. Overall, the analysis of the existing literature on the mentioned issue shows that there are no severe debates on the effectiveness of prone position for adult inpatients with COVID during ventilation.
Although prone positioning is believed to be necessary during ventilation, it still has some limitations, such as pregnancy or open abdominal wounds. In addition to that, Araujo et al. (2021) report that a prone position might cause hemodynamic instability and poor perfusion if a patient suffers from “arterial hypotension, increased intra-abdominal pressure, and hypovolemia” (p. 7). In spite of positive evidence on the effects of lying prone, it is still necessary to remember that coronavirus is a poorly researched disease, and the evidence base is not extensive enough (Chad and Sampson, 2020). This means that the issue of positioning of adult inpatients with COVID-19 during pulmonary ventilation requires further investigation.
The Article that Best Supports Nursing Interventions
The articles described in the preceding section provide a comprehensive overview of prone positioning and its relation to the treatment of coronavirus. Nonetheless, the comparison of the listed articles enables the author of the present essay to conclude that Qadri et al. (2020) more than authors of other papers support nursing intervention. It is possible to argue that Qadri et al.’s (2020) conclusions are based on the analysis of only seven articles, which is insufficient. Nonetheless, these seven articles were chosen out of 8,675 studies (Qadri et al., 2020). In other words, these seven articles are the most appropriate and accurate ones.
It is essential to mention that while Qadri et al. (2020) have analyzed more than 8,500 articles, Araujo et al. (2021) have examined only 2,441 studies. The number of studies analyzed by Chad and Sampson (2020) and Khan et al. (2020) remains unclear. The effectiveness of the article of Henderson et al. (2014) could not be compared to the other four ones since it was written long before the pandemic of COVID-19 and simply discusses the effectiveness of prone positioning for the treatment of patients with ARDS.
The most pressing fact that distinguishes the study of Qadri et al. (2020) from the other four is that it contains statistical data on the correlation between positioning during ventilation and the following consequences. For example, the authors write that 95% of patients show no critical adverse effects after having ventilation in a prone position (Qadri et al., 2020). This data means that the tolerance rate of the procedure is high.
Another significant competitive advantage of this article is that it pays a lot of attention to the incompatibility of certain patients health conditions with the conduction of ventilation in a prone position. Araujo et al. (2021) and Khan et al. (2020) also devote their attention to this issue. Nonetheless, none of them writes about the danger of prone position for patients with “central cannulation for extracorporeal membrane oxygenation (ECMO) or ventricular assist devices” (Qadri et al., 2020, p.240). It is crucial that Qadri et al. (2020) inform nurses which features should be checked in a patient before putting him into a prone position.
To conclude the final section of the present paper, it should be noted that the article written by Qadri et al. (2020) is believed to provide the best support for the necessity to put patients into prone posture because of the extensive sampling. The article also discusses several important aspects of a prone position, including the most basic explanation of what it is, limitations to a prone position, and alternatives to it. All the articles discuss the same issue and come to the same conclusions; none of them provides evidence against the prone position for treatment of inpatients diagnosed with COVID-19. However, in contrast to the other four articles, this one proved to be the most comprehensive and persuasive one for the reasons listed above.
Araujo, M. S. D., Santos, M. M. P. D., Silva, C. J. D. A., Menezes, R. M. P. D., Feijao, A. R., & Medeiros, S. M. D. (2021). Prone positioning as an emerging tool in the care provided to patients infected with COVID-19: a scoping review. Revista Latino-Americana de Enfermagem, 29, 1-12. Web.
Chad, T., & Sampson, C. (2020). Prone positioning in conscious patients on medical wards: A review of the evidence and its relevance to patients with COVID-19 infection. Clinical Medicine, 20(4), e97–e103. Web.
Henderson, W. R., Griesdale, D. E., Dominelli, P., & Ronco, J. J. (2014). Does prone positioning improve oxygenation and reduce mortality in patients with acute respiratory distress syndrome? Canadian Respiratory Journal, 21(4), 213-215. Web.
Khan, S., Choudry, E., Mahmood, S. U., Mulla, A. Y., & Mehwish, S. (2020). Awake Proning: A Necessary Evil During the COVID-19 Pandemic. Cureus, 12(7): e8989. Web.
Qadri, S. K., Ng, P., Toh, T. S. W., Loh, S. W., Tan, H. L., Lin, C. B.,… & Lee, J. H. (2020). Critically Ill Patients with COVID-19: A Narrative Review on Prone Position. Pulmonary Therapy, 6, 233–246. Web.
World Health Organization (2021). WHO coronavirus disease (COVID-19) dashboard. Web.