Physiotherapy-led awake proning for a frail elderly patients with COVID-19: A case study

Abstract

Coronavirus disease (COVID-19) can cause significant damage to the lungs, potentially resulting in acute respiratory distress syndrome (ARDS) (Weatherald et al. 2020). An adjunct of treatment for this is awake proning to improve oxygenation and may prevent intubation (Paul et al. 2020). This case report describes a self-ventilating 85-year-old gentleman with COVID-19 and acute hypoxemia, who experienced significant improvements in oxygenation with proning. His ceiling of care was high flow oxygen therapy (HFNC) on the ward and it was deemed clinically appropriate to commence a trial of physiotherapy led awake proning. Although the patient failed to meet the criteria outlined by the Intensive Care Society (ICS) guidelines for awake proning, after multi-disciplinary (MDT) discussion, it was felt a trial of awake proning should be piloted in the patient’s best interest. He was on 15L oxygen via non-rebreather mask for a number of days as he was acutely delirious and not tolerating HFNC. With proning, an average reduction in oxygen of nearly 20% was noted with an increase in SpO2 of 4.6%. Over a 3-week period his oxygen requirements and saturation levels improved dramatically which could be assosicated with awake proning. Our case study illustrates that awake proning can form a vital part of the COVID-19 management plan. It played a crucial role in the patient’s recovery despite not meeting the criteria set out by the ICS. This highlights that guidelines are recommendations and need to be considered on a case-to-case basis along with clinical judgement and MDT discussion.