PT  - JOURNAL ARTICLE
AU  - Jha, Akhilesh
AU  - Chen, Fangyue
AU  - Mann, Sam
AU  - Shah, Ravi
AU  - Abu-Youssef, Randa
AU  - Pavey, Holly
AU  - Lin-Jia-Qi, Helen
AU  - Cara, Josh
AU  - Cunningham, Daniel
AU  - Fitzpatrick, Kate
AU  - Goh, Celine
AU  - Ma, Renee
AU  - Mookerjee, Souradip
AU  - Nageshwaran, Vaitehi
AU  - Old, Timothy
AU  - Oxley, Catherine
AU  - Jordon, Louise
AU  - Selvan, Mayurun
AU  - Wood, Anna
AU  - Ying, Andrew
AU  - Zhang, Chen
AU  - Wozniak, Dariusz
AU  - Goodhart, Iain
AU  - Early, Frances
AU  - Fisk, Marie
AU  - Fuld, Jonathan
TI  - Physiological effects and subjective tolerability of prone positioning in COVID-19 and healthy hypoxic challenge
AID  - 10.1183/23120541.00524-2021
DP  - 2022 Jan 01
TA  - ERJ Open Research
PG  - 00524-2021
VI  - 8
IP  - 1
4099  - http://openres.ersjournals.com/content/8/1/00524-2021.short
4100  - http://openres.ersjournals.com/content/8/1/00524-2021.full
SO  - erjor2022 Jan 01; 8
AB  - Background Prone positioning has a beneficial role in coronavirus disease 2019 (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 three 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 53–75). Proning led to an increase in oxygen saturation measured by pulse oximetry (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.Awake prone positioning in patients with #COVID19 causes a small increase in SpO2 within 10 min of proning but is associated with increased subjective discomfort, and challenges in the identification of hospital patients suitable for the procedure https://bit.ly/3wg84BC