Detailed Changes in Oxygenation following Awake Prone Positioning for Non-Intubated Patients with COVID-19 and...

Few studies have reported on the effectiveness of awake prone therapy in the clinical course of coronavirus disease (COVID-19) patients. This study aimed to investigate the effects of awake prone therapy during spontaneous breathing on the improvement of oxygenation over 3 weeks for COVID-19 acute respiratory failure. Data of consecutive COVID-19 patients with lung disorder with a fraction of inspired oxygen (F_IO₂) ≥ 0.4 and without tracheal intubation were analyzed. We examined changes in SpO₂/F_IO₂, ROX index ((SpO₂/F_IO₂)/respiratory rate) and the seven-category ordinal scale after the initiation of F_IO₂ ≥ 0.4 and compared these changes between patients who did and did not receive prone therapy. Of 58 patients, 27 received awake prone therapy, while 31 did not. Trend relationships between time course and change in SpO₂/F_IO₂ and ROX index were observed in both groups, although a significant interaction in the relationship was noted between prone therapy and change in SpO₂/F_IO₂ and ROX index. The seven-category ordinal scale also revealed a trend relationship with time course in the prone therapy group. The awake prone therapy was significantly associated with a lower rate of tracheal intubation. In patients with COVID-19 pneumonia treated with F_IO₂ ≥ 0.4, awake prone therapy may improve oxygenation within two weeks.