Evaluation of the outcomes of adjunctive awake-proning as a novel approach to the management of COVID-19 pneumonitis in a level 1 hospital ward setting

Abstract

In response to pressure on United Kingdom healthcare services due to the COVID-19 pandemic, a decision was made to pre-emptively awake-prone hypoxic patients with COVID-19 pneumonitis in a non intensive care unit (ICU) setting, with the aim of improving oxygenation and patient outcomes. This approach was trialled over 30 days from 30th March 2020, awake-proning patients for up to 15 hours a day in the first 72 hours of commencement. This case series was retrospectively analysed to characterise patients who tolerated the intensive regime (group A) versus those who ceased awake-proning early (group B). Additionally, length of stay in days was evaluated in the two groups. In total, 36 patients were proned – with an average of 2% point increase in oxygen saturations. Of these, 21 patients tolerated the intensive regime (average 1878 minutes/72 hours). Of the 15 people who ceased early (971 minutes/72 hours), only 4 were due to intolerable side effects. There were no major significant differences in baseline clinical characteristics between the two groups. Length of stay was significantly reduced in group A over group B even when adjusted for confounding of ICU stay (7.2 compared to 15.2 days p = 0.049). In conclusion awake-proning was successfully delivered in a level 1 setting, requiring the addition of 2 extra physiotherapy staff only. Further exploration is needed to explore the association of intensive regimes with reduced length of stay.