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VOLUME 24 , ISSUE 10 ( October, 2020 ) > List of Articles

Original Article

Awake Prone Positioning in COVID-19 Patients

Prabhanjan Singh, Prerana Jain, Himanshu Deewan

Keywords : Awake prone position, Coronavirus, COVID-19, SARS-CoV-2

Citation Information : Singh P, Jain P, Deewan H. Awake Prone Positioning in COVID-19 Patients. Indian J Crit Care Med 2020; 24 (10):914-918.

DOI: 10.5005/jp-journals-10071-23546

License: CC BY-NC 4.0

Published Online: 30-10-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: WHO has declared SARS-CoV-2 as pandemic. Patients with COVID-19 present mainly with respiratory symptoms. Prone position has been traditionally used in acute respiratory distress syndrome (ARDS) to improve oxygenation and prevent barotrauma in ventilated patients. Awake proning is being used as an investigational therapy in COVID to defer invasive ventilation, improve oxygenation, and outcomes. Hence, we conducted a retrospective case study to look for benefits of awake proning with oxygen therapy in non-intubated COVID patients. Materials and methods: A retrospective case study of 15 COVID patients admitted from June 15 to July 1, 2020 to HDU in our hospital was conducted. Co-operative patients who were hemodynamically stable and SpO2 < 90% on presentation were included. Oxygen was administered through facemask, non rebreathing mask and non invasive ventilation to patients as per requirement. Patients were encouraged to maintain prone position and target time was 10–12 hours/day. SpO2 and P/f ratio in supine and prone position was observed till discharge. Primary target was SpO2 > 95% and P/f > 200 mm Hg. Other COVID therapies were used according to institutional protocol. Results: The mean SpO2 on room air on admission was 80%. In day 1 to 3, the mean P/f ratio in supine position was 98.8 ± 29.7 mm Hg which improved to 136.6 ± 38.8 mm Hg after proning (p = 0.005). The difference was significant from day 1 to 10. Two patients were intubated. The mean duration of stay was 11 days. Conclusion: Awake prone positioning showed marked improvement in P/f ratio and SpO2 in COVID-19 patients with improvement in clinical symptoms with reduced rate of intubation. Highlights: • Prone position ventilation improves oxygenation by reducing VQ mismatch. • Awake prone positioning has been used along with high-flow oxygen therapy in recent pandemic of SARS-CoV-2 virus for management of mild to moderate cases.


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