Early, Awake Proning Feasible, Safe In Select COVID-19 Patients

Early, awake proning appears to be safe and feasible in some COVID-19 patients, according to a new observational study.

Among 22 patients evaluated in the study, inspired oxygen ratio (SpO2:FiO2) increased by a median of 5 after proning, Dr. Nicole M. Dubosh and colleagues from Beth Israel Deaconess Medical Center and Harvard Medical School, in Boston, and colleagues found.

Although the study lacked a control group, proning's "immediate temporal association with improved oxygenation" suggests a causal relationship, the authors write in The American Journal of Emergency Medicine.

Proning can improve oxygenation and reduce mortality in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), and was associated with improved oxygenation in a retrospective study of 15 awake, non-intubated patients, Dr. Dubosh and her team note.

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"Recent small, prospective cohorts of patients with COVID-19 suggest immediate benefit in oxygenation in this population," they add.

The authors looked at the effects of an awake proning protocol on oxygenation in non-intubated COVID-19 patients with mild to moderate respiratory distress. Patient-selection criteria included having respiratory symptoms and oxygen saturation below 93% necessitating supplemental oxygen with nasal cannula or a non-rebreather mask, and being able to follow commands and self-prone.

The median proning time during which vital signs were measured was 109 minutes, and ranged from 19 to 294 minutes. Median SpO2:FiO2 was 295 in the five minutes before proning and 298 for the first 5-35 minutes of proning (P=0.01). Respiratory rate did not change significantly.

Five patients required intubation within 48 hours of being admitted to the ED, and two more were intubated after 48 hours. They spent a median of 19 days on ventilation. Nine patients were admitted to the intensive-care unit. Two patients died in the hospital.

"Proning may provide yet another mechanism to improve oxygenation and avoid the need for mechanical ventilation when used alone or in combination with other modalities like high-flow oxygen," Dr. Dubosh and her colleagues write. "While our study suggests oxygenation may improve with proning, whether progression to intubation was decreased or outcomes improved remains unknown and will require randomized trials to better assess."

—Reuters Staff

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