Airway pressure release ventilation (APRV) and prone position in severe acute respiratory distress syndrome due to SARS-CoV-2: case report

COVID-19 had a wide spectrum of clinical manifestations, from asymptomatic to severe forms. A significant percentage of infected subjects develop acute respiratory distress syndrome (ARDS). Objective: Use of prone position and airway pressure release ventilation (APRV) to improve oxygenation in a patient with COVID-19 ARDS. Clinical case: 73-year-old patient, with diabetes and high blood pressure, presented with a diagnosis of severe COVID-19 pneumonia, which required the use of invasive mechanical ventilation (IMV). In the context of poor oxygenation, difficult sedation and blood gas deterioration, APRV is started. With the progression of pulmonary involvement, ventilatory strategies were not very fruitful, so it was decided to use prone + APRV. Results: a total of 574 hours in IMV and 274 hours in prone divided into 3 cycles of duration. The first cycles of prone + APRV were relevant in terms of improvements in PaO₂/FiO₂ (PaFi), however, from the third prone event, there were no significant changes. Conclusions: prone + APRV was adequate to the patient's requirements, however, the clinical course of the disease produced irreversible deterioration.