- In this series of hypoxic awake patients with COVID-19, self-proning was associated for most of them with marked improvements in oxygen saturation (SpO2).
- Authors recommend early proning when possible.
- Prospective trials are needed.
Why this matters
- Prone positioning has already been linked to reduced intubation rates and better outcomes in awake patients with acute respiratory distress syndrome.
- Early intubation of COVID-19 patients has been associated with high mortality, yet positive pressure ventilation can pose aerosolization risks to providers.
- Some, whom clinicians have dubbed the “happy hypoxemics,” have “pathophysiology confounded existing disease patterns.”
- Median age, 59 years.
- Median SpO2:
- At triage: 80% (interquartile range [IQR], 69%-85%).
- After 5 minutes of supplemental oxygen: 84% (IQR, 75%-90%).
- After 5 minutes of proning+unchanged supplemental oxygen: 94% (IQR, 90%-95%; P=.001).
- 24% (n=13) required intubation within 24 hours of presentation, 7 within 1 hour of proning.
- Of the 37 not requiring intubation at 24 hours, 5 ultimately did by 72 hours.
- Observational cohort study of a convenience sample of 50 conscious, hypoxic adults with documented SARS-CoV-2 infection in a New York City emergency department.
- Participants presented with hypoxia that did not resolve with supplemental oxygen (nonrebreather mask or nasal cannula at 5 L/minute).
- Outcomes: SpO2 after self-proning and supplemental oxygen; intubation.
- Funding: None disclosed.
- Small single-center nonexperimental case series.
- Causation not established.