Abstract
Background Prone positioning has a beneficial role in COVID-19 patients receiving ventilation but lacks evidence in awake non-ventilated patients, with most studies being retrospective, lacking control populations and information on subjective tolerability.
Methods We conducted a prospective, single-centre study of prone positioning in awake non-ventilated patients with COVID-19 and non-COVID-19 pneumonia. The primary outcome was change in peripheral oxygenation in prone versus supine position. Secondary outcomes assessed effects on end-tidal CO2, respiratory rate, heart rate, and subjective symptoms. We also recruited healthy volunteers to undergo proning during hypoxic challenge.
Results 238 hospitalised patients with pneumonia were screened; 55 were eligible with 25 COVID-19 patients and 3 non-COVID-19 patients agreeing to undergo proning – the latter insufficient for further analysis. 10 healthy control volunteers underwent hypoxic challenge. Patients with COVID-19 had a median age of 64 years (interquartile range [IQR] 53–75). Proning led to an increase in SpO2 compared to supine position (difference +1.62%; p=0.003) and occurred within 10 min of proning. There were no effects on end-tidal CO2, respiratory rate, or heart rate. There was an increase in subjective discomfort (p=0.003), with no difference in breathlessness. Among healthy controls undergoing hypoxic challenge, proning did not lead to a change in SpO2 or subjective symptom scores.
Conclusion Identification of suitable patients with COVID-19 requiring oxygen supplementation from general ward environments for awake proning is challenging. Prone positioning leads to a small increase in SpO2 within 10 min of proning though is associated with increased discomfort.
Footnotes
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Conflict of interest: Akhilesh Jha has nothing disclose.
Conflict of interest: Fangyue Chen has nothing disclose.
Conflict of interest: Sam Mann has nothing disclose.
Conflict of interest: Ravi Shah has nothing disclose.
Conflict of interest: Randa Abu-Youssef has nothing disclose.
Conflict of interest: Holly Pavey has nothing disclose.
Conflict of interest: Helen Lin-Jia-Qi has nothing disclose.
Conflict of interest: Josh Cara has nothing disclose.
Conflict of interest: Daniel Cunningham has nothing disclose.
Conflict of interest: Kate Fitzpatrick has nothing disclose.
Conflict of interest: Celine Goh has nothing disclose.
Conflict of interest: Renee Ma has nothing disclose.
Conflict of interest: Souradip Mookerjee has nothing disclose.
Conflict of interest: Vaitehi Nageshwaran has nothing disclose.
Conflict of interest: Timothy Old has nothing disclose.
Conflict of interest: Catherine Oxley has nothing disclose.
Conflict of interest: Louise Jordon has nothing disclose.
Conflict of interest: Mayurun Selvan has nothing disclose.
Conflict of interest: Anna Wood has nothing disclose.
Conflict of interest: Andrew Ying has nothing disclose.
Conflict of interest: Chen Zhang has nothing disclose.
Conflict of interest: Dariusz Wozniak has nothing disclose.
Conflict of interest: Iain Goodhart has nothing disclose.
Conflict of interest: Frances Early has nothing disclose.
Conflict of interest: Marie Fisk has nothing disclose.
Conflict of interest: Jonathan Fuld has nothing disclose.
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- Received August 25, 2021.
- Accepted October 25, 2021.
- Copyright ©The authors 2021
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