Efficacy of early prone or lateral positioning in patients with severe COVID-19: a single-center prospective cohort

Abstract

Background Position intervention has been shown to improve oxygenation, but its role in non-invasively ventilated severe COVID-19 patients has never been assessed. The objective of this study was to investigate the efficacy of early position intervention on non-invasively ventilated severe COVID-19 patients. Methods This was a single-center, prospective observational study in consecutive severe COVID-19 patients managed in a provisional ICU at Renmin Hospital of Wuhan University during January 31st to February 15th, 2020. Patients with chest CT showing exudation or consolidation in bilateral peripheral and posterior part of the lungs were included. Early position intervention (prone or lateral) was commenced for > 4 hours daily for 10 days, while others had standard care. Results The baseline parameters were comparable between position intervention group (n = 17) and standard care group (n = 35). Position intervention was well-tolerated and increased cumulative adjusted mean difference of SpO2/FiO2 (409, 95% CI 86 to 733) and ROX index (26, 95% CI 9 to 43) with decreased Borg scale (−9, 95 CI −15 to −3) during first 7 days. It also facilitated absorption of lung lesions and reduced patients of high National Early Warning Score 2 (≥ 7) on days 7 and 14 with a trend toward fastened clinical improvement. Virus shedding and length of hospital stay were comparable between the two groups. Conclusions This study provides the first evidence for improved oxygenation and lung lesion absorption using early position intervention in non-invasively ventilated severe COVID-19 patients and warrants further randomized trials.

Effect of Awake Prone Positioning in non-Intubated COVID-19 Patients with Acute Hypoxemic Respiratory Failure: A Systematic Review and Meta-Analysis

“…Finally, 22 studies with a total of 5146 patients were included in the meta-analysis. [21][22][23][24][25][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]…”

Clinical update on COVID-19 for the emergency clinician: Airway and resuscitation

“…Guidelines recommend that for patients with an increasing oxygen requirement, but no other indication for intubation, awake prone positioning can be used [ 7 ]. While the prone position is the most common position utilized, patients may also lie on their sides [ [75] , [76] , [77] ]. Another variation has been described in which the patient sits on a chair and rests in a semi-prone position with their chest on an elevated/flat surface [ 78 ].…”

Efficacy and safety of prone position in COVID-19 patients with respiratory failure: A systematic review and meta-analysis

“…Four RCTs [18-21] included 1,283 patients (sample size range, 27-1,121), six prospective cohort studies [5,7,[22][23][24][25] 729 patients (sample size range, 38-335), and 10 retrospective cohort studies [6, 8, 9, 26-32] 2,865 patients (sample size range, 20-827). Nine studies [6,8,20,21,23,26,[30][31][32] originated in Europe, four [5,19,24,25] from Asia, three [22,28,29] from South America, two [9,27] from the US, one [7] from Africa, and one [18] from multiple countries. Eight studies [5,7,9,20,[25][26][27][28] were conducted at single centers and others at multiple centers.…”

“…Nine studies [6,8,20,21,23,26,[30][31][32] originated in Europe, four [5,19,24,25] from Asia, three [22,28,29] from South America, two [9,27] from the US, one [7] from Africa, and one [18] from multiple countries. Eight studies [5,7,9,20,[25][26][27][28] were conducted at single centers and others at multiple centers. In most of the studies, including the four RCTs [18-21], patients were provided through the COT, HFNC, or NIV, and in two cohort studies [9,31], through mechanical ventilation.…”

“…S6). Six cohort studies [5,9,24,28,30,32] reported adverse events in the prone group, which were mainly mild (very low certainty of evidence, Additional File 4, Table S1).…”