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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: 25-01-2021

Copyright Statement:  Copyright © 2020; The Author(s).


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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  1. Singhal T. A review of coronavirus disease-2019 (COVID-19). Indian J Pediatr 2020;87(4):281–286. DOI: 10.1007/s12098-020-03263-6.
  2. Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - the latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis 2020;91:264–266. DOI: 10.1016/j.ijid.2020. 01.009.
  3. Jain N, Choudhury A, Sharma J, Kumar V, De D, Tiwari R. A review of novel coronavirus infection (coronavirus disease-19). Glob J Transfus Med 2020;5(1):22–26. DOI: 10.4103/GJTM.GJTM_24_20.
  4. Couzin-Frankel J. The mystery of the pandemic's ‘happy hypoxia’. Science 2020;368(6490):455–456. DOI: 10.1126/science.368. 6490.455.
  5. Tobin MJ, Laghi F, Jubran A. Why COVID-19 silent hypoxemia is baffling to physicians. Am J Respir Crit Care Med 2020(3). DOI: 10.1164/rccm.202006-2157CP.
  6. Wilkerson RG, Adler JD, Shah NG, Brown R. Silent hypoxia: a harbinger of clinical deterioration in patients with COVID-19. Am J Emerg Med 2020. S0735-6757(20)30390-9 10.1016/j.ajem.2020.05.044.
  7. Koulouras V, Papathanakos G, Papathanasiou A, Nakos G. Efficacy of prone position in acute respiratory distress syndrome patients: a pathophysiology-based review. World J Crit Care Med 2016;5(2):121–136. DOI: 10.5492/wjccm.v5.i2.121.
  8. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368(23):2159. DOI: 10.1056/NEJMoa1214103.
  9. Taccone P, Pesenti A, Latini R, Polli F, Vagginelli F, Mietto C, et al. Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. JAMA 2009;302(18):1977. DOI: 10.1001/jama.2009.1614.
  10. Ghelichkhani P, Esmaeili M. Prone position in management of COVID-19 patients; A commentary. Arch Acad Emerg Med 2020;8(1):e48.
  11. Carsetti A, Damia Paciarini A, Marini B, Pantanetti S, Adrario E, Donati A. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective. Crit Care 2020;24(1):225. DOI: https://doi.org/10.1186/s13054-020-02956-w.
  12. Marini JJ, Gattinoni L. Management of COVID-19 respiratory distress. JAMA 2020;323(22):2329–2330. DOI: 10.1001/jama.2020.6825.
  13. Tobin. MJ. Basing respiratory management of COVID-19 on physiological principles. Am J Respir Crit Care Med 2020;201(11):1319–1336. DOI: 10.1164/rccm.202004-1076ED.
  14. Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: Different respiratory treatments for different phenotypes? Intensive Care Med 2020(6). DOI: 10.1007/s00134-020-06033-2.
  15. Tobin MJ, Laghi F, Jubran A. Caution about early intubation and mechanical ventilation in COVID-19. Ann Intensive Care 2020;10(1):78. DOI: 10.1186/s13613-020-00692-6.
  16. Villarreal-Fernandez E, Patel R, Golamari R, Khalid M, DeWaters A, Haouzi P. A plea for avoiding systematic intubation in severely hypoxemic patients with COVID-19 associated respiratory failure. Crit Care 2020;24(1):337. DOI: 10.1186/s13054-020-03063-6.
  17. Thompson AE, Ranard BL, Wei Y, Jelic S. Prone positioning in awake, nonintubated patients with COVID-19 hypoxemic respiratory failure. JAMA Intern Med 2020. e203030. DOI: 10.1001/jamainternmed.2020.3030.
  18. Caputo ND, Strayer RJ, Levitan R. Early self-proning in awake, non-intubated patients in the emergency department: a single ED's experience during the COVID-19 pandemic. Acad Emerg Med 2020;27(5):375–378. DOI: 10.1111/acem.13994.
  19. Ding L, Wang L, Ma W. Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-center prospective cohort study. Crit Care 2020;24(1):28. DOI: 10.1186/s13054-020-2738-5.
  20. Xu Q, Wang T, Qin X. Early awake prone position combined with high-flow nasal oxygen therapy in severe COVID-19: a case series. Crit Care 2020;24(1):250. DOI: 10.1186/s13054-020-02991-7.
  21. Qin S, Haibo Q, Mao H, Yi Y. Lower mortality of COVID-19 by early recognition and intervention: Experience from Jiangsu Province. Ann Intensive Care 2020;10(1):3. DOI: 10.1186/s13613-020-00650-2.
  22. Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 2020;56(1):105949. DOI: 10.1016/j.ijantimicag.2020. 105949.
  23. Bonovas S, Piovani D. Compassionate use of remdesivir in Covid-19. N England J Med 2020;382(25):e101. DOI: 10.1056/NEJMc2015312.
  24. Robinson. J. Dexamethasone is ‘first drug’ to be shown to improve survival in COVID-19. Pharmaceut J 2020;304(7938):online 10.1211/PJ.2020.20208074.
  25. Kewan T, Covut F, Al-Jaghbeer MJ, Rose L, Gopalakrishna KV, Akbik. B. Tocilizumab for treatment of patients with severe COVID19: a retrospective cohort study. E Clin Med 2020;24:100418. DOI: 10.1016/j.eclinm.2020.100418.
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