Role of awake prone positioning in patients with moderate-to-severe COVID-19: an experience from a developing country

https://doi.org/10.4081/monaldi.2021.1561

Authors

  • Iffat Khanum | iffat.khanum.ik@gmail.com Department of Medicine, Section of Infectious Diseases, The Aga Khan University Hospital, Karachi, Pakistan. https://orcid.org/0000-0002-4982-2799
  • Fatima Samar Department of Medicine, Section of Infectious Diseases, The Aga Khan University Hospital, Karachi, Pakistan. https://orcid.org/0000-0002-4617-129X
  • Yousuf Fatimah Department of Medicine, Section of Infectious Diseases, The Aga Khan University Hospital, Karachi, Pakistan. https://orcid.org/0000-0001-9247-3857
  • Awan Safia Department of Medicine, Section of Infectious Diseases, The Aga Khan University Hospital, Karachi, Pakistan.
  • Aziz Adil Department of Medicine, Section of Infectious Diseases, The Aga Khan University Hospital, Karachi, Pakistan.
  • Habib Kiren Department of Medicine, Section of Infectious Diseases, The Aga Khan University Hospital, Karachi, Pakistan. https://orcid.org/0000-0002-9543-6231
  • Nasir Nosheen Department of Medicine, Section of Infectious Diseases, The Aga Khan University Hospital, Karachi, Pakistan. https://orcid.org/0000-0003-1610-8748
  • Mahmood Faisal Department of Medicine, Section of Infectious Diseases, The Aga Khan University Hospital, Karachi, Pakistan. https://orcid.org/0000-0002-3390-7659
  • Jamil Bushra Department of Medicine, Section of Infectious Diseases, The Aga Khan University Hospital, Karachi, Pakistan.

Abstract

There is limited evidence on the efficacy of awake prone positioning (PP) in non-ventilated patients with COVID-19 who have hypoxemia. We, therefore, aim to describe our experience with the use of early proning in awake, non-intubated patients with confirmed COVID-19. In our retrospective observational study, 23 patients with confirmed positive PCR test results for Severe Acute respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and hypoxemia that required oxygen therapy with or without non-invasive ventilation were treated with PP. Patients were classified into mild, moderate and severe COVID-19 disease. There were no targeted number of hours for proning per day and patients were kept in prone position according to their tolerance. The primary outcome measure was the avoidance of intubation and secondary outcomes were in-hospital mortality, length of hospital stays and complications related to PP. The mean (standard deviation) age of our cohort was 54.5 (11.7) years, and the majority were males (21/23, 91.3%). Sixty-one per cent (14/23) of the patients were suffering from severe disease and 82.6% (19/23) had bilateral lung involvement with interstitial infiltrates. Majority of the patients were prone positioned for a median of 6 days (IQR 4 – 8). Only one patient required transfer to ICU for mechanical ventilation and subsequently died due to severe ARDS. All 22 patients showed progressive improvement in oxygen requirement and PF ratio, mostly after 3-5 days of proning. The mean length of hospital stay was 12 days. All patients, except one, were discharged in stable conditions, on room air or on a minimal oxygen requirement of 1-2 liters. No major complication of PP was recorded. Awake prone positioning is a valuable and safe therapeutic adjunct that can be applied in patients with moderate-to-severe COVID-19. It can also be included in the home-based management protocols of COVID-19 to improve patient outcomes and mitigate the burden on health care facilities.

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Published
2021-03-05
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COVID-19 - Collection of articles on the Coronavirus outbreak
Keywords:
COVID-19, SARS-CoV-2, prone position, awake proning, pandemic
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How to Cite
Khanum, Iffat, Fatima Samar, Yousuf Fatimah, Awan Safia, Aziz Adil, Habib Kiren, Nasir Nosheen, Mahmood Faisal, and Jamil Bushra. 2021. “Role of Awake Prone Positioning in Patients With Moderate-to-Severe COVID-19: An Experience from a Developing Country”. Monaldi Archives for Chest Disease 91 (2). https://doi.org/10.4081/monaldi.2021.1561.

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