Early prone positioning therapy for patients with mild COVID-19 disease

Abstract

Objective In December 2019, Wuhan, China, experienced an outbreak of coronavirus disease 2019 (COVID-19). Some patients admitted to our hospital were treated with early prone positioning (PP). Here, we analyzed its clinical significance. Methods This was a retrospective observational study. We defined the early PP group as mild COVID-19 patients who were placed into a prone position within 24 h of admission; others served as the control group. We recorded basic data and outcomes of early PP and compared the results to those of controls. Results After 1 day of treatment, oxygenation was greater in the early PP group than in the control group (P/F: 421.6 ± 39.74 vs. 382.1 ± 38.84 mmHg [1 mmHg = 0.133 kPa], p < 0.01). And early PP group spent less total time in prone position (11.1 ± 4.17 vs. 16.9 ± 5.20 days, p < 0.01), and required shorter hospitalization duration (12.2 ± 4.49 vs. 23.2 ± 4.83 days, p < 0.001). Conclusions Early PP treatment can improve hypoxia and shorten the prone position time and hospitalization duration in mild COVID-19 patients. It is a potential clinically applicable intervention.

Does awake prone positioning prevent the use of mechanical respiratory support or death in COVID-19 patients on standard oxygen therapy hospitalised in general wards? A multicentre randomised controlled trial: the PROVID-19 protocol

“…17 In COVID-19 patients who initially need only standard low flow oxygen therapy and still are sufficiently well to allow admission in medical wards, awake prone positioning has been mostly evaluated in observational studies focusing on oxygenation settings and only two small-sized randomised controlled trials. [18][19][20][21][22][23][24][25] In a cluster randomised controlled trial in 27 COVID-19 patients, oxygen needs in terms of oxygen flow tended to be lower in the prone position group. 26 The second trial was stopped early (30 patients were included) because of lack of patients' adherence to the scheduled sessions of prone positioning, and did not show improved oxygenation in the intervention group.…”

Prone position in COVID 19-associated acute respiratory failure

“…Seventeen studies (12 observational, 9 retrospective [15][16][17][18][19][20][21][22][23] and 3 prospective [24][25][26], and 5 RCTs [27][28][29][30][31]) met our inclusion criteria (Table 1). Six studies were done in the ICU and 11 outside the ICU (Table 1).…”