Prone positioning in non‐intubated patients with coronavirus – A single‐centre experience in Hong Kong

Abstract

Introduction:Significant ventilator‐associated pneumonia and mortality were found in COVID‐19 patients who required mechanical ventilation which calls for non‐invasive means in managing respiratory failure.Methods:We retrospectively reviewed patients admitted to the intensive care unit of Pamela Youde Nethersole Eastern Hospital in Hong Kong with severe acute respiratory syndrome coronavirus 2 infection from 28 November to 15 December 2020. Patients’ laboratory, respiratory parameters and outcome data were recorded and analysed.Results:Eleven received prone ventilation. The median age was 67 (inter‐quartile range: 59–72) years, and median COVID‐19 GRAM score was 151 (inter‐quartile range: 133–181), representing a high‐risk group. There were significant improvements 1 h after awake proning in SpO2 (95% vs 92%, p = 0.008), FiO2 (0.4 vs 0.5, p = 0.003), SpO2/FiO2 (240 vs 184, p = 0.005), respiratory rate (19 vs 26, p = 0.006) and respiratory rate – oxygenation index (13.22 vs 7.67, p = 0.003; Table 1). Although not reaching statistical significance, the median PaO2, PaCO2 and PaO2/FiO2 improved after proning. The overall intubation rate was 22% and intensive care unit mortality was 22%, which is in contrast to 65.5% and 27.6%, respectively, in the first three waves. Although did not reach statistical significance, those received prone ventilation tend to have a lower ICU mortality (9.1% vs 42.9%, p = 0.245) and hospital mortality (18.2% vs 42.9%, p = 0.326).Conclusion:Awake proning potentially minimizes complications from invasive ventilation and provides a low‐cost low‐risk treatment option in COVID‐19 patients with respiratory failure. This is particularly important when healthcare resources are strained at times of a pandemic.