Patient self-proning with high-flow nasal cannula improves oxygenation in COVID-19 pneumonia

Slessarev, Marat; Cheng, Jason; Ondrejicka, M; Arntfield, Robert

doi:10.1007/s12630-020-01661-0

Cited by 75 publications

(96 citation statements)

References 8 publications

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“…Second, the sample size is small considering the nature of an observational study. Although we noticed that a single case report 30 and a pilot study 31 c: CT scans before treatment revealed multiple bilateral ground-glass opacities and consolidation, and the score was 50.…”

Section: / 1mentioning

confidence: 85%

Early Awake Prone and Lateral Position in Non-intubated Severe and Critical Patients with COVID-19 in Wuhan: A Respective Cohort Study

Dong

Yang

Feng

et al. 2020

Preprint

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BackgroundPrevious studies suggest applying prone position (PP) and lateral position (LP) in patients with severe acute respiratory distress syndrome (ARDS) for their efficacy in improving oxygenation and lung recruitment.This paper aims to share clinical experiences and outcome of using PP and LP in combination with oxygen therapy (OT) andNon-invasive ventilation (NIV) in severe and critical patients with COVID-19. MethodsClinical data of 48 severe and critical patients have been retrieved from medical records and reviewed. The primary outcome is the survival rate. Secondary outcome is the rate of patients requiring intubation. ResultsIn total, 25 patients were finally included in the study.The mean respiratory rate of all 25 patients decreased from 28.4 breaths/min to 21.3 breaths/min. CT results showed increase in lung recruitment. All patients tolerated PP and LP well. No deterioration or severe adverse events associated with PP and LP occurred. All patients recovered and survived without intubation. Follow-up to date showed that all patients have been discharged except one with mild symptoms and positive RNA test. Conclusion:Clinical outcomes of early application of PP and LP in combination with OT and NIV in severe and critical patients with COVID-19 indicated well tolerance of the therapy and resulted in improving patients' oxygenation in a safe and effective manner. Therefore, this strategy can be explored as an early intervention in managing patients in early stage of disease development under the context of pandemic and limited medical resources.

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Section: / 1mentioning

confidence: 85%

Early Awake Prone and Lateral Position in Non-intubated Severe and Critical Patients with COVID-19 in Wuhan: A Respective Cohort Study

Dong

Yang

Feng

et al. 2020

Preprint

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“…Hypercapnia is less likely to be "silent", considering that even small increases in arterial carbon dioxide tension elicit feedback response from pH-sensitive central chemoreceptors to increase respiratory drive. Although our model suggests that oxygen equilibration must be less than 5% to produce high ratios of Fshu:Finj, it is possible that 214 elimination of carbon dioxide is less impaired given that diffusion of carbon dioxide across the 215 alveolar-capillary membrane is roughly 20-fold faster than that of oxygen 3 which may reduce baseline perfusion gradients compared to supine positioning 22 , and is also reportedly beneficial for COVID-19 patients 23,24 . Therefore, our model may explain a mechanism by which pulmonary vasodilators and prone positioning may improve ventilation-toperfusion matching and reduce hypoxia, perhaps providing palliative care for COVID -19 patients.…”

Section: Discussionmentioning

confidence: 96%

Can Hyperperfusion of Nonaerated Lung Explain COVID-19 Hypoxia?

Herrmann

Mori

Bates

et al. 2020

Preprint

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Early stages of the novel coronavirus disease (COVID-19) have been associated with ‘silent hypoxia’ and poor oxygenation despite relatively small fractions of afflicted lung. Although it has been speculated that such paradoxical findings may be explained by impairment of hypoxic pulmonary vasoconstriction in infected lungs regions, no studies have confirmed this hypothesis nor determined whether such extreme degrees of perfusion redistribution are physiologically plausible. Here, we present a mathematical model which provides evidence that the extreme amount of pulmonary shunt observed in patients with early COVID-19 is not plausible without hyperperfusion of the relatively small fraction of injured lung, with three-fold increases in regional perfusion to afflicted regions. Although underlying perfusion heterogeneity (e.g., due to gravity or pulmonary emboli) exacerbated existing shunt in the model, the reported severity of hypoxia in early COVID-19 patients could not be replicated without considerable reduction of vascular resistance in nonoxygenated regions.

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“…Selfpronation has been recommended albeit with high ow nasal oxygen (HFNC). 10 Slessarev et al in 2020, reported that the prone position results in more even distribution of lung tissue leading to further uniform alveolar distribution and pulmonary perfusion and thereby improving oxygenation which prevents worsening of dyspnea, reduces lung oedema and progression of the disease. The authors proposed that HFNC can meet oxygen demands while allowing patients to manage their body position independently through self-proning.…”

Section: Discussionmentioning

confidence: 99%

“…This care approach would be bene cial to under-resourced countries where hitech ICU techniques may not be available. 10 Current evidence suggests that the coagulation cascade is signi cantly disrupted during SARS-CoV-2 infection and predisposes patients to thrombosis due to excessive in ammation, platelet activation, stasis and endothelial dysfunction. 11,12 The case report by Di Tiano et al (2020), highlights the risk of thrombotic complications after COVID-19 infections and supports the use of effective anti-thromobotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Remote clinician-based home management of COVID-19 associated pneumonia in a resource limited setting

Kana¹,

Maharaj²

2020

Preprint

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The coronavirus disease (COVID-19) pandemic has resulted in an increased number of patients that require respiratory support in terms of oxygen and ventilation. Due to the burden on the healthcare system there has been a shortage of hospitals beds in both the public and private sector. This has led to many patients being managed at home. Currently there is no consensus regarding best practice guidelines in terms of treatment of this subset of patients.We hereby present a case of a patient who was treated using appropriate respiratory support (a combination of low flow oxygen therapy via nasal prongs or face mask as high flow oxygen was not available), oral corticosteroids and anti-coagulants managed by remote clinician intervention. We also include our home management protocol.

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Patient self-proning with high-flow nasal cannula improves oxygenation in COVID-19 pneumonia

Cited by 75 publications

References 8 publications

Early Awake Prone and Lateral Position in Non-intubated Severe and Critical Patients with COVID-19 in Wuhan: A Respective Cohort Study

Early Awake Prone and Lateral Position in Non-intubated Severe and Critical Patients with COVID-19 in Wuhan: A Respective Cohort Study

Can Hyperperfusion of Nonaerated Lung Explain COVID-19 Hypoxia?

Remote clinician-based home management of COVID-19 associated pneumonia in a resource limited setting

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