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Response to Awake Prone Position in Nonintubated Individuals With COVID-19.

Vanessa M Oliveira1, Ruy A Barcellos2, Daniele M Piekala2

  • 1Prone Teaching and Research Group, ICU Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. vmoliveira@hcpa.edu.br.

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|November 24, 2021
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Summary

Awake prone positioning can decrease intubation risk and improve outcomes for patients with moderate acute respiratory distress syndrome (ARDS). Responders experienced reduced mortality, shorter ICU stays, and less need for mechanical ventilation.

Keywords:
ARDSCOVID-19awake pronehypoxemic respiratory failureintubationprone positioning

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Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Respiratory Physiology

Background:

  • Prone positioning is established for invasively ventilated ARDS patients.
  • Its efficacy in non-intubated, awake patients with ARDS remains less clear.
  • This study investigates awake prone positioning for COVID-19 ARDS.

Purpose of the Study:

  • To evaluate the effectiveness of awake prone positioning in reducing intubation risk.
  • To assess the impact of prone maneuver on favorable outcomes in awake ARDS patients.
  • To determine if prone positioning improves gas exchange and clinical outcomes.

Main Methods:

  • Prospective evaluation of 66 COVID-19 ARDS patients treated with non-invasive support.
  • Patients underwent awake prone positioning; outcomes and gas exchange were monitored.
  • Responders defined by a 20% increase in PaO2/FiO2 ratio; intubation rates and clinical outcomes analyzed.

Main Results:

  • Forty-one subjects were enrolled; responders showed significant improvements in PaO2, PaCO2, and PaO2/FiO2 ratio.
  • Responders had significantly lower intubation rates (48h), shorter ICU and hospital stays, and reduced mortality.
  • Awake prone positioning responders demonstrated a 54% reduction in ventilation risk.

Conclusions:

  • Awake prone positioning is effective in improving oxygenation and clinical outcomes for moderate ARDS patients.
  • Patients responding to the maneuver experienced significantly better outcomes, including reduced mortality and shorter hospitalizations.
  • The prone maneuver offers a potential non-invasive strategy to mitigate ARDS severity and complications.