EC Pulmonology and Respiratory Medicine

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

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