Feasibility and Limitations of Proning Protocol for Nonintubated Patients With COVID-19

Shoults, Benjamin; Barber, Mary; Millham, Lucia; Mulla, Maaz; Nanji, Natasha; Steele, Grant; Peck, Tyler; Smithedajkul, Patrick; Worsham, Christopher; Currier, Paul F.; Raphaely, Rebecca A

doi:10.1177/2374373520981486

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…Even though prolonged duration of proning is associated with improved outcome, awake patients cannot tolerate prolonged proning more than 2 to 3 hours. [21,22] Our results are similar to other cohort studies done in the era of COVID-19. Ding and colleagues evaluated the effect of adding awake prone positioning to high-flow nasal cannula oxygen and non-invasive ventilation in 20 patients with moderate-to-severe ARDS.…”

Section: Discussionsupporting

confidence: 90%

Awake prone positioning for COVID-19 patients at Eka Kotebe General Hospital, Addis Ababa, Ethiopia: A prospective cohort study

Asrat

Huluka

Getachew

et al. 2021

JPATS

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Objectives: The objectives of the study were to evaluate the benefit of awake prone positioning in COVID-19 patients hospitalized at Eka Kotebe General Hospital, Addis Ababa, Ethiopia. Materials and Methods: Consecutive patients with COVID-19 who require supplemental oxygen to maintain oxygen saturation of ≥90% during the month of October 2020 were enrolled. Structured questionnaires were employed to collect data. Admission oxygen saturation was recorded for each patient before and after their first proning session. Analysis of descriptive and comparison statistics was done using SPSS version 25. Results: A total of 61 patients were included in the study. The mean age (+SD) for the cohort was 55.4 (+16.9) years. The average duration of proning was 5+2.5 h/session and 8+6 h/day. The average oxygen saturation before proning was 89% (SD 5.2) and 93% (SD 2.8) 1 h after proning (P < 0.001); supplemental oxygen requirements significantly decreased with prone ventilation, before proning: FiO2 0.33 (+0.14) versus 1 h after prone ventilation: FiO2 0.31 (+0.13) (P < 0.001). Oxygen improvement with prone ventilation was not associated with duration of illness or total prone position hours. When assessed at 28 days after admission, 55.7% (n = 34) had been discharged home, 1.6% (n = 1) had died, and 42.6 (n = 26) were still hospitalized. Conclusion: Awake prone positioning demonstrated improved oxygen saturation in our oxygen requiring COVID-19 patients. Even though further studies are needed to support causality and determine the effect of proning on disease severity and mortality, early institution of prone ventilation in appropriate oxygen requiring COVID-19 patients should be encouraged.

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Section: Discussionsupporting

confidence: 90%

Awake prone positioning for COVID-19 patients at Eka Kotebe General Hospital, Addis Ababa, Ethiopia: A prospective cohort study

Asrat

Huluka

Getachew

et al. 2021

JPATS

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“…Majority of the patients believed it was a difficult posture to maintain and an uneasy maneuver to perform. Another study done on patient's perspective about COVID-19 at Harvard University also showed similar results (11). Other studies also found discomfort, coughing, and uncooperativeness as the main reasons for not performing a proning procedure while awake proning (12,13).…”

Section: Discussionmentioning

confidence: 59%

Patient’s Perspective of Awake Proning: A Cross-Sectional Interview-Based Survey From COVID-19–Recovered Patients

Sethi

Hirani

Iqbal

et al. 2022

Critical Care Explorations

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IMPORTANCE AND OBJECTIVES: To assess the knowledge, attitude, and practice of the patients who underwent prone positioning during their COVID-19 illness in the hospital. DESIGN: Cross-sectional study. SETTING: Aga Khan University Hospital, Karachi, Pakistan. PARTICIPANTS: COVID-19–recovered patients. INTERVENTIONS: None. MAIN OUTCOMES AND MEASURES: Knowledge was assessed by five questions with a dichotomous response (yes/no). An yes response was awarded 1 score. Since there were five questions, five would be the highest score. Patients’ perceptions of the therapy were assessed by four questions, each scored on a Likert scale of 5 (5 = strongly agree, 4 = agree, 3 = neither agree nor disagree, 2 = disagree, and 1 = strongly disagree). As it had four questions, the maximum score achieved could therefore be 20. Proning practices were assessed using seven questions: four were used to calculate practice scores, whereas three were open-ended regarding the patient’s experience. Each question carries a different score, and the maximum score was 8. RESULTS: The study included 98 patients. The mean age of the patients was 57 years (sd, 12.2 yr). Majority of the patients were males (70.4%). 69.1% of males and 76.6% of females fell in the poor knowledge group. The poor knowledge cohort had an educational level of 48% in high school, 45.5% in graduates, and 6% in postgraduates. Compared with 56.5% of males, 73% of females preferred prone positioning. Sixty percent of those with a high school education viewed prone positioning favorably, whereas 46% of those with graduate and postgraduate did. Seventy-nine percent of males and 63% of females scored positively on the practice questionnaire. Eighty percent of graduates and postgraduates preferred proning practices to 67% of participants with high school education levels. CONCLUSIONS AND RELEVANCE: Our study population had a little understanding of awake proning, found it unpleasant, and practiced for a shorter period than advised. Despite the overall negative attitude toward the position, our patients highly recommend this position to future patients.

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“…Similarly, Coppo et al 32 found no adverse events related to the APP procedure. In contrast, Shoults et al in United States 38 discovered that all patients rated discomfort as the primary factor for being unable to resume a PP session. Since the beginning of the pandemic, there have been few case reports of patients with COVID‐19 with respiratory difficulties after self‐proning.…”

Section: Discussionmentioning

confidence: 92%

Effects of awake‐prone positioning on oxygenation and physiological outcomes in non‐intubated patients with COVID‐19: A randomized controlled trial

Othman

Elmenshawy

Mohamed

2022

Nursing in Critical Care

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Background Prone positioning is a well‐known supportive approach for increasing oxygenation and reducing mortality in non‐COVID‐19 patients with moderate to severe acute respiratory distress syndrome. However, studies highlighting the effects of proning in patients with COVID‐19 are limited. Aim To investigate the effects of awake‐prone positioning (APP) on oxygenation and physiological outcomes in non‐intubated patients with COVID‐19. Study Design A randomized controlled trial was carried out with two parallel groups at 1:1 ratio. Adult awake non‐intubated patients with confirmed COVID‐19, non‐rebreathing face mask or continuous positive airway pressure, PaO 2 /FiO 2 ratio ≤150 mmHg were randomly assigned to the APP group or control group. The control group was subjected to conventional positioning interventions. Outcome measures were PaO 2 /FiO 2 ratio, ROX index, PaO 2 , PaCO 2 , SaO 2 , respiratory rate, blood pressure, and shock index. These parameters were recorded immediately before positioning, 10 min after patient positioning, and 1 h after patient positioning. Results Of 115 patients assessed for eligibility, 82 were randomized to the APP group or control group (41 patients in each group). The use of APP for non‐intubated patients with COVID‐19 resulted in statistically significant improvements in oxygenation parameters, that is, SpO 2 , PaO 2 /FiO 2 , ROX index, PaO 2 , and SaO 2 , at the three study time points ( p = .000, .007, .000, .011, and .000 respectively). The SpO 2 was increased to 92.15 ± 2.735 mmHg for the APP group versus 88.17 ± 4.847 for the control group after 1 h of patients' positioning. The PaO 2 /FiO 2 ratio increased in the APP group before proning compared with 1 h after proning (79.95 ± 22.508 vs. 98.91 ± 34.44) respectively. APP improved the SpO 2 , PaO 2 /FiO 2 , ROX index, PaO 2 , and SaO 2 values for the APP group, representing an increase of 5.85%, 23.71%, 30.79%, 22.59%, and 5.26%, respectively. Conclusion Awake proning in non‐intubated patients with COVID‐19 showed marked improvement in oxygenation and physiological parameters. Relevance to Clinical Practice This study provides evidence for critical care nurses to implement APP in non‐intubated patients with COVID‐19 to improve oxygenation and physiological parameters, as it w...

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Feasibility and Limitations of Proning Protocol for Nonintubated Patients With COVID-19

Cited by 7 publications

References 9 publications

Awake prone positioning for COVID-19 patients at Eka Kotebe General Hospital, Addis Ababa, Ethiopia: A prospective cohort study

Awake prone positioning for COVID-19 patients at Eka Kotebe General Hospital, Addis Ababa, Ethiopia: A prospective cohort study

Patient’s Perspective of Awake Proning: A Cross-Sectional Interview-Based Survey From COVID-19–Recovered Patients

Effects of awake‐prone positioning on oxygenation and physiological outcomes in non‐intubated patients with COVID‐19: A randomized controlled trial

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