Pros of prone positioning with high-flow nasal oxygenation in morbidly obese patients with moderate-to-severe COVID-19 acute respiratory distress syndrome: A retrospective analysis

Background: Coronavirus disease-2019 has rapidly spread globally and has become a global public health crisis. Obesity is the most frequent comorbidity exhibited by severe acute respiratory syndrome coronavirus-2. Many studies have highlighted the benefits of prone position (PP) with high flow nasal oxygenation (HFNC) in patients with moderate to severe acute respiratory distress syndrome (ARDS). This further delay intubation, reduce intensive care unit (ICU) stay and decreases overall morbidity. Methods: In this study, we analyzed case record data of morbidly obese patients (body mass index >35Kg/m2) with moderate-to-severe ARDS over 3 months. We evaluated the efficacy of early application of PP with HFNO in morbidly obese patients with moderate-to-severe COVID-19 ARDS on PaO2/FiO2 ratio. Results: A total of 24 morbidly obese patients were included in the study. Patients were divided into two groups: Group F (those who were intubated) and Group S (who did not require invasive mechanical ventilation). One hour of PP along with the use of HFNO, the P/F ratio was significantly higher in Group S (78.23 ± 7.16) than in Group F (63.58 ± 15.40) (P < 0.05). The ICU stay was longer in patients who required invasive mechanical ventilation, 17.33±2.52 days in Group F as compared to 8.11±1.05 days in Group S. Conclusion: PP with HFNO seems safe in morbidly obese patients and may improve oxygenation more than in nonobese patients. It is important to stress the necessity to start out postural treatment as early because the patient's clinical condition permits. PP with HFNO might avoid tracheal intubation and its inherent risks and prove beneficial in resource-limited scenarios.