Early self-proning of conscious COVID-19 patients is linked to improved oxygenation

  • Acad Emerg Med

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.” 

Key results

  • 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.

Study design

  • 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.

Limitations

  • Small single-center nonexperimental case series.
  • Causation not established.