Role of awake prone positioning in patients with moderate-to-severe COVID-19: an experience from a developing country

Abstract

There is limited evidence on the efficacy of awake prone positioning (PP) in non-ventilated patients with COVID-19 who have hypoxemia. We, therefore, aim to describe our experience with the use of early proning in awake, non-intubated patients with confirmed COVID-19. In our retrospective observational study, 23 patients with confirmed positive PCR test results for Severe Acute respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and hypoxemia that required oxygen therapy with or without non-invasive ventilation were treated with PP. Patients were classified into mild, moderate and severe COVID-19 disease. There were no targeted number of hours for proning per day and patients were kept in prone position according to their tolerance. The primary outcome measure was the avoidance of intubation and secondary outcomes were in-hospital mortality, length of hospital stays and complications related to PP. The mean (standard deviation) age of our cohort was 54.5 (11.7) years, and the majority were males (21/23, 91.3%). Sixty-one per cent (14/23) of the patients were suffering from severe disease and 82.6% (19/23) had bilateral lung involvement with interstitial infiltrates. Majority of the patients were prone positioned for a median of 6 days (IQR 4 – 8). Only one patient required transfer to ICU for mechanical ventilation and subsequently died due to severe ARDS. All 22 patients showed progressive improvement in oxygen requirement and PF ratio, mostly after 3-5 days of proning. The mean length of hospital stay was 12 days. All patients, except one, were discharged in stable conditions, on room air or on a minimal oxygen requirement of 1-2 liters. No major complication of PP was recorded. Awake prone positioning is a valuable and safe therapeutic adjunct that can be applied in patients with moderate-to-severe COVID-19. It can also be included in the home-based management protocols of COVID-19 to improve patient outcomes and mitigate the burden on health care facilities.

Impact of Proning in COVID-19 Patients Admitted in Allama Iqbal Memorial Teaching Hospital Sialkot

“…In the present study, majority of patients were males 40 (90%). This finding was comparable to the previous some studies 11,12 .…”

“…Mortality in group I was 1(4%) and in group II mortality was found 2(8%). No any severe complications were observed among both groups 11 . Proning COVID-19 has been demonstrated to lead to better oxygenation in several minor trials and hypoxemic air failure has been reported.…”

“…In the current study, most of the patients 42(84%) had bilateral lung involvement with interstitial infiltrates 55 (90%) followed by consolidation and unilateral infiltrates. Fever, cough and dyspnea was the most common symptom found in both groups 11,13,14 . Thirty (60%) patients had moderate and 20(40%) had severity of disease.…”

Determine the Impact of Prone Positioning in Covid-19 Patients

“…These findings were comparable to the previous some studies. [11,12] In our study Most of the patients 81 (81%) had bilateral lung involvement (40 in group A and 41 in group B). Interstitial infiltrates was found in 78 (40 in group A and 38 in group B) patients followed by consolidation and unilateral infiltrates.…”

Application of an evidence-based, out-patient treatment strategy for COVID-19: Multidisciplinary medical practice principles to prevent severe disease

“…This improves the oxygen saturation of arterial red blood cell hemoglobin (as demonstrated in the PROSERVA TRIAL). [83][84][85][86][87] General Architecture Overall, this figure is dichotomized by characterizing the features of mild and moderate COVID-19 and the interventions that comprise our regimen to prevent progression to severe disease.…”