Awake self-proning for COVID-19 non-intubated patients—a single-centered experience

Abstract

BackgroundCOVID-19 patients with respiratory failure may need intensive care unit (ICU) admission. Prone positioning in mechanically ventilated patients improves oxygenation and reduces mortality in moderate to severe acute respiratory distress syndrome. For better oxygenation and outcomes, awake proning is being tried in non-intubated patients also. Our aim was to investigate advantage of awake self-prone positioning with oxygen therapy using non-rebreathing mask (NRBM) in COVID-19 ICU patients.ResultsThis prospective observational study was conducted in ICU from 18th November 2020 to 28th February 2021. Sixty COVID-19 cooperative patients with hypoxemia on arrival with hemodynamic stability were included. Patients on NRBM were advised to turn prone for 12–14 h per day. Oxygen saturation (SpO2) was recorded in supine position and 30 min after initiation of prone positioning. Ratio of arterial partial pressure of oxygen and fractional concentration of inspired oxygen (P/F) was recorded in supine and 24 h after initiation of prone position. Primary outcome was improvement in SpO2 > 94%. Secondary outcome was incidence of intubation.Sixty patients were received in ICU with supplemental oxygen, and median SpO2 was 80% (IQR 70–88%). Patients were put on NRBM with median SpO2 in supine position 86% (IQR 76–90). Thirty minutes of proning increased SpO2 to 94% (IQR 89 to 97%). Wilcoxon rank-sum test was used (P = 0.001). Forty-three patients did not require intubation, and seventeen patients needed intubation.ConclusionsAwake self-proning in COVID-19 patients on NRBM improved oxygenation with reduced intubation rate.