DOI: https://doi.org/10.53350/pjmhs211571864 ORIGINAL ARTICLE 1864 P J M H S Vol. 15, NO. 7, JUL 2021 Determine the Impact of Prone Positioning in Covid-19 Patients MUHAMMAD IMRAN 1 , KHALIFA RAHAT RASHED 2 , AMJAD ALI 3 , JAHANGIR ANJUM 4 , MUAZZAM FUAAD 5 , TALAL SAFDAR 6 1 Assistant Professor, General Medicine, Mohiuddin Teaching Hospital, Mirpur AJK 2 House Officer Medicine, Rehman Medical College, Peshawar 3 Professor,Chairman Department of Medicine and Allied, BKMC/MMC, Mardan 4 Assistant professor of Medicine Mohtarma Benazir Bhutto Shaheed Medical College / Divisional Headquarters teaching hospital, Mirpur Azad Kashmir 5 Assistant Professor Medicine, Medical Department Rai Medical College, Sargodha 6 Senior Registrar Medicine, Fauji Foundation Hospital Rawalpindi. Corresponding author: Dr. Amjad Ali, Email: dramjadali75@gmail.com, Cell No: +92 313 3200003 ABSTRACT Objective:To determine the effectiveness of prone positioning in patients of covid-19 deisease presented with respiratory failure. Study Design: Retrospective/Observational study Place and Duration: Medicine department of BKMC/MMC, Mardan and Mohiuddin Teaching Hospital, Mirpur AJK for six months during the period from August 2020 to January 2021. Methods: Total 100 patients of respiratory failure admitted to ICU were included in this study. Patients detailed demographics age,sex and body mass index were recorded after taking informed written consent. Patients were aged between 25-80years.Patients were divided in to two groups I and II. Group A had 50 COVID-19 patients underwent prone position and group Bwith50 patients taken as control. Chest X-ray of both groups were taken. Patients of group A were kept in prone position whilegroup B received invasive ventilation and follow up was taken in duration of 15-days. Reduction of intubation rate, mortality, hospital stay and complications were identified among both groups. Complete data was analyzed by SPSS 22.0 version. Results:Majority of the patients was males 76% and the rest were females 24%. Mean age of the patients in prone positioning group was 52.42±13.18 years with mean BMI 26.14±7.13 kg/m 2 and in control group A itwas 50.44±14.65 years with mean BMI 26.41±7.13 kg/m 2 . 55% patients had moderate and 45% had severe covid-19 disease. Mean duration of prone position was 5.14±6.31 hours. Most of the patients 81% had bilateral lung involvementinterstitial infiltrates. Fever, cough and dyspnea were the most common symptom found in both groups. Mean PF ratio was increases in prone group as compared to controlled group. Mean hospital stay in group A was 12.9±4.76 days and in group B mean hospital stay was 17.32±10.24 days. Mortality in group A was 3 (3%) and in group Bmortality was found in 7 (7%). No any severe complications were observed among both groups. Conclusion:We concludedin this study that the use of prone position among patients of COVID-19 was effective and safe method to reduce intubation, mortality and hospital stay. There was no any complication were found after this treatment. Keywords: Prone Position, Covid-19, Respiratory Failure, Mortality INTRODUCTION NEW VIRUS COVID-19 Affects Respiratory System According to the Surviving Sepsis Campaign panel, every patient with an acute severe respiratory illness should be treated in the Intensive Care Unit (ICU) [2]. For example, around 19 percent of COVID-19-infested people will suffer from hypoxic respiratory failure, and about 14 percent will have severe infections requiring oxygen treatment, and 5 percent would need mechanical ventilation and ICU hospitalization. The 52 patients with severe COVID-19 infection had a 67 percent ARDS rate, and 63.5 percent, 42 percent, and 56 percent of them used high-flow nasal cannula (HFNC), invasive mechanical ventilation, and noninvasive mechanical ventilation, respectively [5] [6]. When it comes to promoting oxygenation in Acute Respiratory Distress Syndrome (ARDS) patients who need mechanical ventilation, prone position is a conventional method. On the other hand, it's well-known that oxygenation is far more beneficial in prone than supine position. Numerous studies have also shown that a prone position may reduce the amount of lung damage caused by ventilators [6, 7]. Because of the heart and its associated organs, the lungs' central posterior portions are prone to be compressed while lying on one's back. When lying on your back in prone posture, the central anterior areas are compressed, increasing cardiac output and facilitating pulmonary respiration [8]. By restricting ventral alveolar expansion and dorsal collapse, prone posture, according to the current thinking, contributes to more equal ventilation. Reduced dorsal-ventral transpulmonary pressure difference, reduced lung compression and increased perfusion result from this [9]. In patients with ARDS and severe hypoxemia (Pao2:Fio2 ratio 150 mm Hg, Fio2 0.6, PEEP 5 cmH2O), prone posture may be beneficial if it's done early and for a long period of time [6, 7]. It is difficult to anticipate how patients would react to prone posture since it may take several forms. Numerous randomized trials and meta-analyses have shown, however, that prone position in combination with a lung- protective approach, when done early and for a sufficient period of time, may improve survival rate among patients with ARDS Decreased 28-day mortality and 90-day mortality, as well as extubation and ventilator-free days, were also seen with prone positioning [10]. It is