Prone Positioning of Patients With Coronavirus Disease 2019 Who Are Nonintubated in Hypoxic Respiratory Distress: Single-Site Retrospective Health Records Review

Abstract

Introduction In March and April 2020 of the COVID-19 pandemic, site clinical practice guidelines were implemented for prone positioning of awake, alert, spontaneously breathing suspected COVID-19 patients in hypoxic respiratory distress. The purpose of this pandemic disaster practice improvement project was to measure changes in pulse oximetry associated with prone positioning on awake, alert, spontaneously breathing non-intubated adult acute respiratory distress, or ARDS, patients with COVID-19 infection. Methods A retrospective chart review of ED COVID-19 positive patients from 3/30/2020 to 4/30/2020 was conducted for patients with a room air pulse oximetry < 90% and a pre-prone position pulse oximetry ≤ 94% who tolerated prone positioning for at least 30 minutes. The primary outcome was change in pulse oximetry associated with prone positioning, measured on room air, with supplemental oxygen, and approximately 30 minutes after initiating prone positioning. Median differences were compared with the Wilcoxon signed-rank test. Results Of the 440 COVID-19 patients, 31 met inclusion criteria. Median pulse oximetry increased as 83% (IQR= 75%-86%) on room air, 90% (IQR=89%-93%) with supplemental oxygen, and 96% (IQR=94%-98%) with prone positioning (x.xx, p<.001). 45% (N=14) were intubated during their hospital stay and 26% (N=8) of the included patients died. Conclusion In awake, alert, and spontaneously breathing patients with COVID-19, an initially low pulse oximetry reading improved with prone positioning. Future studies are needed to determine the association of prone positioning with subsequent endotracheal intubation and mortality.

Physiotherapy management for COVID-19 in the acute hospital setting and beyond: an update to clinical practice recommendations

“… 47 While awake proning is recommended and appears to achieve improvements in oxygenation without any serious adverse events, further evaluation is needed as there is significant variability in its application within current publications and its impact on outcomes such as rate of intubation or mortality rates is unclear. 48 , 49 , 50 , 51 Early implementation of awake proning, for example within 24 hours of a patient requiring high-flow oxygen, may be an important factor. 52 However, awake proning may be uncomfortable for some patients, leading to low adherence.…”

Posisi Pronasi terhadap Oksigenasi Pasien COVID-19 dengan Terapi Oksigen Non-Invasif

“…Satu penelitian memberikan posisi pronasi satu jam setelah pasien makan untuk mencegah efek samping atau komplikasi gastrointestinal (Singh et al, 2020). Dua penelitian memberikan prosedur posisi pronasi dengan posisi tempat tidur reverse Trendelenburg (Sryma et al, 2021;Wendt et al, 2021). Hal ini berbeda dengan panduan dari Intensive Care Society (ICS) tentang posisi pronasi pada pasien COVID-19 dalam kondisi sadar dimana posisi pronasi diberikan pada posisi tempat tidur datar/rata (Bamford et al, 2020).…”

Effect of Eight Hours Per Day of Intermittent Self-Prone Positioning for Seven Days on the Severity of Covid-19 Pneumonia/ Acute Respiratory Distress Syndrome

“…2 The virus emerged in Hubei province of China where its first case was reported in Dec 2019. 3 The virus spread rapidly around the globe and a pandemic was declared by the WHO on March 11 2020. 3 The index case in Pakistan was reported from Karachi on 26th Feb 2020.…”