Case Report
Volume 11 Issue 6 - 2022
Prolonged Prone Ventilation in a Rural Community Hospital during COVID 19 Pandemic Surge: Case Report and Literature Review
Yasser Omar* and Ryan Kerrins
Tennova Healthcare Clarksville, Tennessee, United States
*Corresponding Author: Yasser Omar, Tennova Healthcare Clarksville, Tennessee, United States.
Received: June 13, 2022; Published: June 24, 2022


Background: Prone ventilation (PV) has been a standard of care in critically ill patients with acute respiratory distress syndrome (ARDS). However, it is often underutilized in rural intensive care units. This is largely due to staffing issues and lack of resources which have only been made worse during the SARS-CoV-2 pandemic. Current guidelines suggest at least 12 - 16 hours of prone mechanical ventilation per session. However, during a surge of the pandemic, a rural ICU in Tennessee was gravely understaffed and needed to implement prolonged prone positioning (> 48 hours).

Methods: A literature review of current research that has evaluated prolonged proning (>16 hours). Unfortunately, none of the studies included rural intensive care units. A case report of a patient who underwent prolonged proning in a rural intensive care unit during the SARS-CoV-2 pandemic.

Results: After a three-week hospitalization, the patient was discharged to a subacute rehabilitation center. He did not require a tracheostomy. He did have skin breakdown to the right maxilla and shins. He did not report blurred vision or ocular pain.

Conclusion: Prolonged prone ventilation may be a more feasible option for rural intensive care units that do not have adequate staffing or resources. More research that does not exclude rural intensive care units is needed.

Keywords: Prone Ventilation (PV); Acute Respiratory Distress Syndrome (ARDS); SARS-CoV-2 Pandemic


  1. Dorn AV., et al. “COVID-19 exacerbating inequalities in the US”. Lancet10232 (2020): 1243-1244.
  2. Murthy S., et al. “Care for Critically Ill Patients With COVID-19”. The Journal of the American Medical Association15 (2020): 1499-1500.
  3. Mathews KS., et al. “Prone Positioning and Survival in Mechanically Ventilated Patients with Coronavirus Disease 2019-Related Respiratory Failure”. Critical Care Medicine7 (2021): 1026-1037.
  4. Marini JJ and L Gattinoni. “Time Course of Evolving Ventilator-Induced Lung Injury: The "Shrinking Baby Lung". Critical Care Medicine8 (2020): 1203-1209.
  5. Mueller JT., et al. “Impacts of the COVID-19 pandemic on rural America”. Proceedings of the National Academy of Sciences of the United States of America1 (2021).
  6. Joynt KE., et al. “Mortality Rates for Medicare Beneficiaries Admitted to Critical Access and Non–Critical Access Hospitals, 2002-2010”. The Journal of the American Medical Association13 (2013): 1379-1387.
  7. Joynt KE., et al. “Quality of Care and Patient Outcomes in Critical Access Rural Hospitals”. The Journal of the American Medical Association1 (2011): 45-52.
  8. Cantor J., et al. “Association Between COVID-19 Relief Funds and Hospital Characteristics in the US”. The Journal of the American Medical Association Health Forum10 (2021): e213325-e213325.
  9. Laffey JG., et al. “Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study”. The Lancet Respiratory Medicine8 (2017): 627-638.
  10. Langer T., et al. “Prone position in intubated, mechanically ventilated patients with COVID- 19: a multi-centric study of more than 1000 patients”. Critical Care1 (2021): 128.
  11. Behesht Aeen F., et al. “Effect of prone position on respiratory parameters, intubation and death rate in COVID-19 patients: systematic review and meta-analysis”. Scientific Reports1 (2021): 14407.
  12. Mathews KS., et al. “Prone Positioning and Survival in Mechanically Ventilated Patients with Coronavirus Disease 2019-Related Respiratory Failure”. Critical Care Medicine7 (2021): 1026-1037.
  13. Piehl MA and RS Brown. “Use of extreme position changes in acute respiratory failure”. Critical Care Medicine1 (1976): 13-14.
  14. Munshi L., et al. “Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis”. Annals of the American Thoracic Society4 (2017): S280-S288.
  15. Guerin C., et al. “Prone positioning in severe acute respiratory distress syndrome”. The New England Journal of Medicine23 (2013): 2159-2168.
  16. Alhazzani W., et al. “Surviving Sepsis Campaign Guidelines on the Management of Adults with Coronavirus Disease 2019 (COVID-19) in the ICU: First Update”. Critical Care Medicine3 (2021): e219-e234.
  17. Douglas IS., et al. “Safety and Outcomes of Prolonged Usual Care Prone Position Mechanical Ventilation to Treat Acute Coronavirus Disease 2019 Hypoxemic Respiratory Failure”. Critical Care Medicine3 (2021): 490-502.
  18. Parker EM., et al. “Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19”. Journal of Clinical Medicine13 (2021): 2969.
  19. Carsetti A., et al. “Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective”. Critical Care1 (2020): 225.
  20. Page DB., et al. “Prolonged Prone Positioning for COVID-19-induced Acute Respiratory Distress Syndrome: A Randomized Pilot Study”. Annals of the American Thoracic Society (2021).
Citation: Yasser Omar and Ryan Kerrins. “Prolonged Prone Ventilation in a Rural Community Hospital during COVID 19 Pandemic Surge: Case Report and Literature Review”. EC Pulmonology and Respiratory Medicine 11.6 (2022): 32-35.

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