A Prospective, Descriptive Study on Awake Self-prone in Hospitalized COVID-19 Patients

Abstract

Healthcare workers internationally continue to look for innovative ways to improve patient outcomes and optimize resource utilization during the coronavirus disease 2019 (COVID-19) pandemic. Proning awake, nonintubated patients has been suggested as a potential intervention in critical care. The aim of this study is to provide a multidisciplinary approach to safely perform awake self-prone positioning in the acute care setting. Design: This is a prospective, descriptive study. Method:Patients with COVID-19 were screened and enrolled within 48 hours of a positive test. After approval from the primary team, patients were provided education materials by a multidisciplinary team on the self-prone intervention. Visual cues were placed in the room. Patients were requested to maintain a diary of hours of prone positioning. Patients' baseline characteristics, admission vitals, daily oxygen requirements, and level of care were collected. Results:Of 203 patients screened, 31 were enrolled. No pressure-related injury or catheter (intravenous or urinary) displacement was identified. Eighty-one percent of patients spent less than 8 hours a day in prone positioning. Among patients enrolled, none required invasive ventilation or died. Conclusions: Awake self-proning can be performed safely in patients given a diagnosis of COVID-19 in the acute care setting with a multidisciplinary team.

Experiences of maintaining awake prone positioning in non‐intubated patients with COVID‐19: A qualitative study

“…Some patients felt that their chest was pressed, whereas others experienced stomach discomfort after being placed in the prone position immediately following a meal. These findings were generally consistent with those reported by other studies 19,22,32,33 . Second, patients in this study often expressed a lack of understanding and trust in this postural therapy, especially when they had both respiratory symptoms and fever.…”

“…These findings were generally consistent with those reported by other studies. 19,22,32,33 Second, patients in this study often expressed a lack of understanding and trust in this postural therapy, especially when they had both respiratory symptoms and fever.…”

“…Patient mistrust of awake prone positioning should be dispelled by providing continuous health education, preferably daily during the early stage of the treatment plan and lasting until the patient truly understands the rationale for it. There have been previous studies 22,33 emphasizing the importance of providing health education to patients prior to awake prone positioning, which primarily focused on informative content regarding its proper implementation and conferred benefits. Our study results further validate this suggestion, but we also elaborate on the reasons underlying the need for such health education and further emphasize the frequency with which it should be provided.…”