Towards individualized and optimalized positioning of non-ventilated COVID-19 patients: Putting the affected parts of the lung(s) on top?

Froelich, Sébastien; Mandonnet, Emmanuel; Julla, Jean-Baptiste; Touchard, Cyril; Laloi-Michelin, Marie; Kevorkian, Jean-Philippe; Gautier, Jean-François

Abstract The outbreak of COVID-19 led to an unprecedented inflow of hospitalized patients with severe acute respiratory syndrome (SARS) requiring high-flow non-invasive oxygenation, if not invasive mechanical ventilation. While the best option in terms of non-invasive systems of oxygen delivery is still a matter of debate, it also remains unclear as to whether or not the optimal in-bed positioning of patients might also help to improve their oxygen saturation levels. On the basis of three representative cases, it is possible to propose the following hypotheses: (i) how patients are positioned has a strong influence on their oxygen saturation levels; (ii) saturation-optimalized positions are patient-specific; (iii) prone positions require ergonomic devices; and (iv) saturation-optimalized positions should aim to place the most affected part(s) of the lung(s) on top. Considered together, these hypotheses have led us to recommend that COVID-19 patients should undergo a specific assessment at admission to determine their saturation-optimalized in-bed position. However, further studies are still needed to assess the benefits of such a strategy on clinical outcomes.