RT Journal Article
SR Electronic
T1 Physiological effects and subjective tolerability of prone positioning in COVID-19 and healthy hypoxic challenge
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00524-2021
DO 10.1183/23120541.00524-2021
VO 8
IS 1
A1 Jha, Akhilesh
A1 Chen, Fangyue
A1 Mann, Sam
A1 Shah, Ravi
A1 Abu-Youssef, Randa
A1 Pavey, Holly
A1 Lin-Jia-Qi, Helen
A1 Cara, Josh
A1 Cunningham, Daniel
A1 Fitzpatrick, Kate
A1 Goh, Celine
A1 Ma, Renee
A1 Mookerjee, Souradip
A1 Nageshwaran, Vaitehi
A1 Old, Timothy
A1 Oxley, Catherine
A1 Jordon, Louise
A1 Selvan, Mayurun
A1 Wood, Anna
A1 Ying, Andrew
A1 Zhang, Chen
A1 Wozniak, Dariusz
A1 Goodhart, Iain
A1 Early, Frances
A1 Fisk, Marie
A1 Fuld, Jonathan
YR 2022
UL http://openres.ersjournals.com/content/8/1/00524-2021.abstract
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