Late Breaking Abstract - Prone-Positioning in Awake, Non-Intubated Patients with COVID-19 Hypoxemic Failure: A Single-Center Trial

Abstract

<b>Introduction:</b> A surge in critically ill patients with respiratory failure due to Covid-19 has overwhelmed ICU capacity in many healthcare systems across the world. Given a guarded prognosis and significant resource limitations, less-invasive, inventive approaches such as prone positioning (PP) of non-intubated patients with hypoxemic respiratory failure was considered 1-2. <b>Aims and Objectives:</b> The aim of this study is to evaluate the impact of awake PP at a ward level on oxygenation and clinical outcomes among awake non-intubated patients with Covid-19 pneumonia. The primary outcome for this trial is the change in SpO2:FiO2 (SF) ratio from admission to discharge in the participants who tolerated PP compared to those that did not. Secondary outcomes included amongst others: intubation rate, in-hospital mortality, and length of in-hospital stay. <b>Methods:</b> A total of 63 patients admitted to Beaumont Hospital, Dublin between January and February of 2021 with Covid-19 requiring supplemental oxygen were recruited. Primary outcome measure was the weighted mean difference in oxygenation parameters (SpO2:FiO2 or SF ratio) pre- and post-PP. <b>Results:</b> A total of 47 (74%) participants were reported as tolerating and 16 (26%) as non-tolerating PP. The primary endpoint is the mean change in SF. The mean rank in the tolerating group was 38 vs 16 in the non-tolerating. This was statistically significant (P &lt;0.001). <b>Conclusion:</b> PP was associated with improvements in oxygenation parameters without any reported serious adverse events.&nbsp;A well-designed, randomized control trial, testing the efficacy of PP in non-intubated Covid-19 patients is needed, prior to widespread adoption of this practice.