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Prone positioning in patients treated with non-invasive ventilation for COVID-19 pneumonia in an Italian emergency department
  1. Davide Bastoni,
  2. Erika Poggiali,
  3. Andrea Vercelli,
  4. Elena Demichele,
  5. Valentina Tinelli,
  6. Teresa Iannicelli,
  7. Andrea Magnacavallo
  1. Emergenza, Azienda USL di Piacenza, Piacenza, Italy
  1. Correspondence to Dr Davide Bastoni, Emergenza, Azienda USL di Piacenza, Piacenza 29121, Italy; dbastonidoc{at}


We report the experience of prone ventilation in selected patients treated with helmet non-invasive ventilation (NIV) continuous positive airway pressure (CPAP) for acute respiratory failure in COVID-19 pneumonia. Preliminary results showed an improvement in the PaO2 value and PaO2/FiO2 ratio after 1 hour of prone ventilation. No variation of the lung ultrasound pattern before and after prone ventilation has been detected. At the time of writing, we attempted proning with helmet NIV CPAP in 10 patients. In 4 out of 10 patients, the attempt failed due to lack of compliance of the patient, scarce pain control even with ongoing treatment and refusal by the patient to prone positioning.

  • acute care
  • SARS
  • infectious diseases
  • viral
  • respiratory
  • pneumonia/infections
  • ventilation
  • non invasive

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  • Handling editor Ellen J Weber

  • Contributors DB planned the study and submitted it. ED and TI provided help in collecting data and informed consent by the patients. VT recorded the video and took the images attached to this study. AV created the database and edited the table. AM provided help with ethical approval by local institution and article proof-reading. EP helped with writing and proof-reading the article and the table.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.