Awake proning in COVID-19 patients with acute hypoxic respiratory failure

Abstract

Introduction: SARS-CoV-2 infection often experience hypoxic respiratory failure and invasive mechanical ventilation requirement. As pandemic progresses, ICU beds and mechanical ventilators may become rate-limiting factor. Prone positioning in conscious patients may improve oxygenation avoiding mechanical ventilation. We conducted retrospective study regarding proning in nonintubated patients in COVID ICU.Objective: Primary objective: change in SpO2 and PaO2 in ABG in non intubated COVID-19 patients who underwent awake prone positioning (PP). Secondary objective: PaO2 and PaCO2 variation before and during PP or after resupination. Intubation incidence within 2 weeks of first PP trial.Methodology: This retrospective study was conducted in SMCH from June – July 2020 among awake, nonintubated COVID 19 patients in ICU.Inclusion criteria: Patients with SpO2 >93 % with oxygen by face mask or nasal canula @ 2-10L/min.Exclusion criteria: Altered mental status and impaired consciousness. We collected demographics, vitals, and position data.Prone positioning: Placing patient on his or her stomach with head on side. Patient advised to remain in prone position as long as he can tolerate to maximum of 12hrs/day. Parameters such as HR, BP, SpO2 and PaO2 were measured before and during PP or after resupination at 30mins interval.Result: Our retrospective study, suggest that in COVID-19 patients with mild to moderate acute hypoxic respiratory failure, conscious proning can lead to oxygenation improvement, less invasive ventilation requirement, shorter hospital stay length and better overall outcomes.