BENEFICIAL EFFECTS OF AWAKE PRONE POSITIONING IN COVID-19 PATIENTS WITH MODERATE TO SEVERE HYPOXEMIC RESPIRATORY FAILURE

MA Rana; R Pervaiz; B Arif; F Tariq; SA Tabassum; MH Siddiqui; S Raza; MM Hafeez

doi:10.54112/pjicm.v2021i1.4

Authors

MA Rana Department of Critical Care, Division of Medicine, Bahria International Hospital, Lahore, Pakistan
R Pervaiz Department of Critical Care, Division of Medicine, Bahria International Hospital, Lahore, Pakistan
B Arif Department of Critical Care, Division of Medicine, Bahria International Hospital, Lahore, Pakistan
F Tariq Department of Critical Care, Division of Medicine, Bahria International Hospital, Lahore, Pakistan
SA Tabassum Department of Critical Care, Division of Medicine, Bahria International Hospital, Lahore, Pakistan
MH Siddiqui Associate Professor of Medicine, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
S Raza Department of Critical Care, Division of Medicine, Bahria International Hospital, Lahore, Pakistan
MM Hafeez Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore Pakistan

DOI:

https://doi.org/10.54112/pjicm.v2021i1.4

Keywords:

prone positioning, COVID-19, hypoxic respiratory failure, awake prone positioning, self-prone position, ARDS, V/Q mismatch

Abstract

Introduction: Coronavirus disease (COVID-19) is a leading cause of acute hypoxemic respiratory failure which can progress to acute respiratory distress syndrome (ARDS). These patients are deeply sedated, paralyzed and ventilated and prone positioning is known to help in these cases. Prone positioning has been known to help in ARDS cases, but they are ventilated deeply sedated and paralyzed. The aim of the current study was to assess the safety and potential benefits of awake prone positioning in COVID-19 patients with moderate to severe hypoxemic respiratory failure. Methods: This is a retrospective cohort study, performed at Bahira International Hospital Lahore. Record of confirmed COVID-19 patients with hypoxic respiratory failure was reviewed thoroughly to collect data. The duration, timing, frequency, tolerability, beneficial effects and adverse events during prone positioning were recorded from the medical records before and after self-prone positioning. Results: The current analysis showed that prone positioning is supportive to maintain good saturation (92%) as compared to keeping patients in spine position (82%). Conclusion: It can be concluded from the current study that prone position is helpful to maintain normal oxygen saturation even on low oxygen supply, helping in quick recovery and preventing oxygen induced damage to the lungs.

References

Ali, J., Ali, Q., Hafeez, M. M., & Malik, A. (2020). Clinical features, diagnosis and treatment of COVID-19. Biological and Clinical Sciences Research Journal, 2020, e032.

Bamford, P., Bentley, A., Dean, J., Whitmore, D., and Wilson-Baig, N. (2020). ICS guidance for prone positioning of the conscious COVID patient 2020. United Kingdom: Intensive Care Society.

Elharrar, X., Trigui, Y., Dols, A.-M., Touchon, F., Martinez, S., Prud’homme, E., and Papazian, L. (2020). Use of prone positioning in nonintubated patients with COVID-19 and hypoxemic acute respiratory failure. Jama 323, 2336-2338.

Mady, A. F., Ramdan, O., Al Yousef, R., Ishag, A., Bakirova, G., Kuhail, A., ... & Harthy, A. (2020). COVID 19 critical care training surge experience for physicians in riyadh health cluster one, Saudi Arabia. Biological and Clinical Sciences Research Journal, 2020(1), e041-e041.

Pavlov, I., He, H., McNicholas, B., Perez, Y., Tavernier, E., Trump, M. W., Jackson, J. A., Zhang, W., Rubin, D. S., and Spiegel, T. (2020). Awake Prone Positioning in Non-intubated Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19: a Systematic Review and Meta-analysis.

Siddique, A., Fateh, A., Idrees, N., Ali, Q., Hafeez, M. M., & Malik, A. (2020). The epidemics of COVID-19. Biological and Clinical Sciences Research Journal, 2020(1), e030-e030.

Sarma, A., and Calfee, C. S. (2020). Prone positioning in awake, Nonintubated patients with COVID-19: necessity is the mother of invention. JAMA Internal Medicine 180, 1539-1540.

Sartini, C., Tresoldi, M., Scarpellini, P., Tettamanti, A., Carcò, F., Landoni, G., and Zangrillo, A. (2020). Respiratory parameters in patients with COVID-19 after using noninvasive ventilation in the prone position outside the intensive care unit. Jama 323, 2338-2340.

Scholten, E. L., Beitler, J. R., Prisk, G. K., and Malhotra, A. (2017). Treatment of ARDS with prone positioning. Chest 151, 215-224.

Slessarev, M., Cheng, J., Ondrejicka, M., and Arntfield, R. (2020). Patient self-proning with high-flow nasal cannula improves oxygenation in COVID-19 pneumonia. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 67, 1288-1290.

Tabassum, S. A., Bibi, T., Tariq, F., TARIQ, S., Raza, S., Hafeez, M., & Rana, M. (2020). Unusual leukemoid reaction in a COVID-19 patient: A case report. Biological and Clinical Sciences Research Journal, 2020(1), e034.

Telias, I., Katira, B. H., and Brochard, L. (2020). Is the prone position helpful during spontaneous breathing in patients with COVID-19? Jama 323, 2265-2267.