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Effect of proning in patients with COVID-19 acute hypoxemic respiratory failure receiving noninvasive oxygen therapy
PB Sryma1, Saurabh Mittal1, Anant Mohan1, Karan Madan1, Pawan Tiwari1, Sushma Bhatnagar2, Anjan Trikha3, Ravi Dosi4, Shweta Bhopale2, Renjith Viswanath3, Vijay Hadda1, Randeep Guleria1, Bhvya Baldwa1
1 Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Department of Anesthesiology and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
4 Department of Pulmonary Medicine, Motherhood Hospital, Indore, Madhya Pradesh, India
Correspondence Address:
Dr. Saurabh Mittal
Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/lungindia.lungindia_794_20
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Background: Novel coronavirus (SARS-CoV-2) infection is associated with hypoxemic respiratory failure. Mechanical ventilation (MV) is reported to have high mortality in SARS-CoV-2 acute respiratory distress syndrome. We aimed to investigate whether awake prone positioning (PP) can improve oxygenation and prevent intubation when employed early. Methods: This prospective interventional study included proven coronavirus disease 2019 (COVID-19) patients with room air saturation 93% or less. The primary outcome was the rate of intubation between the two groups. The secondary outcomes included ROX index (SpO2/FiO2%/respiratory rate, breaths/min) at 30 min following the intervention, ROX index at 12 h, time to recovery of hypoxemia, and mortality. Results: A total of 45 subjects were included (30 cases and 15 controls) with a mean (standard deviation [SD]) age of 53.1 (11.0) years. The age, comorbidities, and baseline ROX index were similar between the two groups. The median duration of PP achieved was 7.5 h on the 1st day. The need for MV was higher in the control group (5/15; 33.3%) versus prone group (2/30; 6.7%). At 30 min, there was a statistically significant improvement in the mean (SD) ROX index of cases compared with that of the controls (10.7 [3.8] vs. 6.7 [2.6], P < 0.001). No significant adverse effects related to intervention were noted. Conclusion: Awake PP is associated with significant improvement in oxygenation and may reduce the need for MV in subjects with COVID-19.
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