PT  - JOURNAL ARTICLE
AU  - Akhilesh Jha
AU  - Fangyue Chen
AU  - Sam Mann
AU  - Ravi Shah
AU  - Randa Abu-Youssef
AU  - Holly Pavey
AU  - Helen Lin-Jia-Qi
AU  - Josh Cara
AU  - Daniel Cunningham
AU  - Kate Fitzpatrick
AU  - Celine Goh
AU  - Renee Ma
AU  - Souradip Mookerjee
AU  - Vaitehi Nageshwaran
AU  - Timothy Old
AU  - Catherine Oxley
AU  - Louise Jordon
AU  - Mayurun Selvan
AU  - Anna Wood
AU  - Andrew Ying
AU  - Chen Zhang
AU  - Dariusz Wozniak
AU  - Iain Goodhart
AU  - Frances Early
AU  - Marie Fisk
AU  - Jonathan Fuld
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