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Prone position protocol in awake COVID-19 patients: A prospective study in the emergency department
Saqer Althunayyan1, Abdulaziz M Almutary2, Mohammad Asim Junaidallah2
1Department of Accident and Trauma, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia.
Insights
Prone positioning significantly improved oxygenation and reduced respiratory distress in awake, non-intubated COVID-19 patients in the emergency department. This intervention shows promise for managing hypoxemic patients before ICU admission.
Area of Science:
- Emergency Medicine
- Critical Care Medicine
- Pulmonology
Background:
- Effective interventions for COVID-19 patients with respiratory failure in the emergency department (ED) are limited.
- Prone positioning is a known method to improve oxygenation in intensive care unit (ICU) settings.
Purpose of the Study:
- To describe and assess the utility of prone positioning in awake, non-intubated adult COVID-19 patients within the ED.
- Evaluate the impact of prone positioning on oxygenation and respiratory parameters in this patient population.
Main Methods:
- A prospective cohort study was conducted on hypoxic COVID-19 adult patients presenting to the ED.
- Data on vital signs and physiological parameters were collected before and after a four-hour prone positioning protocol.
- Key outcomes included oxygenation (SpO2/FiO2 ratio), respiratory rate, respiratory distress score, ICU admission, and intubation rates.
Main Results:
- The study included 49 male patients with a mean age of 53.37 years.
- A significant increase in the mean SpO2/FiO2 ratio (from 1.62 to 1.99) and a decrease in respiratory rate (from 32.45 to 26.29) were observed post-proning.
- Respiratory distress scores also significantly decreased; 48.9% were admitted to the ICU, 12.2% were intubated, and 14.3% died.
Conclusions:
- Prone positioning in the ED led to significant, immediate improvements in oxygenation, respiratory rate, and respiratory distress.
- A correlation was noted between improved oxygenation and reduced ICU admission rates.
- Further research is recommended to fully ascertain the benefits regarding ICU admission, intubation, and mortality.
Background:
Limited effective interventions exist in the emergency department (ED) for COVID-19 patients with respiratory failure. One of the promising interventions is the prone position, which has been proven to improve oxygenation in ICU settings. Here, we aimed to describe and assess the utility of the prone position in awake non-intubated adult patients in EDs during the COVID-19 pandemic.
Methods:
We conducted a prospective cohort study of hypoxic COVID-19 adult patients who presented to our emergency department. We collected the data from June to the end of August 2020, including vital signs and physiological and clinical parameters before and after completing the four-hour prone position protocol. The main outcomes assessed were improvement in oxygenation, respiratory rate, respiratory distress score, ICU admission, and intubation. Oxygenation was calculated based on the standard pulse oximeter saturation [SpO2]/fractional concentration of oxygen in inspired air (FiO2).
Results:
The study included 49 patients (81.63% men; mean age, 53.37 ± 11 years). The mean oxygen saturation during the triage was 84.49% ± 7.98 on room air. After completing of the four-hour prone protocol, the mean SpO2/FiO2 ratio increased from 1.62 ± 0.78-1.99 ± 0.75 (p < 0.0001). The respiratory rate decreased from 32.45 ± 5.24-26.29 ± 5.40 (p < 0.0001). Respiratory distress scores decreased after changing patients' positions (p < 0.0001). Twenty-four patients (48.9%) were admitted to the ICU, 6 patients were intubated (12.2%), and 7 (14.3%) died in the hospital.
Conclusion:
After applying the prone position in the ED, significant and immediate improvement was observed in oxygenation, respiratory rate, respiratory distress, and carbon dioxide levels. A linear relationship between the level of improvement in oxygenation and reduction in ICU admission was observed. However, further studies recommended to assess the advantage of the procedure in terms of ICU admission, intubation, or mortality.
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