tetano
Editor, Senior Moderator
ERJ Open Res
. 2021 Feb 7;8(1):00524-2021.
doi: 10.1183/23120541.00524-2021. eCollection 2022 Jan.
Physiological effects and subjective tolerability of prone positioning in COVID-19 and healthy hypoxic challenge
Akhilesh Jha[SUP] 1 2 3 [/SUP], Fangyue Chen[SUP] 2 3 [/SUP], Sam Mann[SUP] 4 [/SUP], Ravi Shah[SUP] 2 [/SUP], Randa Abu-Youssef[SUP] 1 [/SUP], Holly Pavey[SUP] 1 [/SUP], Helen Lin-Jia-Qi[SUP] 4 [/SUP], Josh Cara[SUP] 4 [/SUP], Daniel Cunningham[SUP] 5 [/SUP], Kate Fitzpatrick[SUP] 4 [/SUP], Celine Goh[SUP] 4 [/SUP], Renee Ma[SUP] 4 [/SUP], Souradip Mookerjee[SUP] 4 [/SUP], Vaitehi Nageshwaran[SUP] 2 [/SUP], Timothy Old[SUP] 2 [/SUP], Catherine Oxley[SUP] 4 [/SUP], Louise Jordon[SUP] 2 [/SUP], Mayurun Selvan[SUP] 2 [/SUP], Anna Wood[SUP] 4 [/SUP], Andrew Ying[SUP] 4 [/SUP], Chen Zhang[SUP] 4 [/SUP], Dariusz Wozniak[SUP] 6 [/SUP], Iain Goodhart[SUP] 5 [/SUP], Frances Early[SUP] 2 [/SUP], Marie Fisk[SUP] 1 2 [/SUP], Jonathan Fuld[SUP] 2 [/SUP]
Affiliations
Abstract
Background: Prone positioning has a beneficial role in coronavirus disease 2019 (COVID-19) patients receiving ventilation but lacks evidence in awake non-ventilated patients, with most studies being retrospective, lacking control populations and information on subjective tolerability.
Methods: We conducted a prospective, single-centre study of prone positioning in awake non-ventilated patients with COVID-19 and non-COVID-19 pneumonia. The primary outcome was change in peripheral oxygenation in prone versus supine position. Secondary outcomes assessed effects on end-tidal CO[SUB]2[/SUB], respiratory rate, heart rate and subjective symptoms. We also recruited healthy volunteers to undergo proning during hypoxic challenge.
Results: 238 hospitalised patients with pneumonia were screened; 55 were eligible with 25 COVID-19 patients and three non-COVID-19 patients agreeing to undergo proning - the latter insufficient for further analysis. 10 healthy control volunteers underwent hypoxic challenge. Patients with COVID-19 had a median age of 64 years (interquartile range 53-75). Proning led to an increase in oxygen saturation measured by pulse oximetry (SpO[SUB]2[/SUB]) compared to supine position (difference +1.62%; p=0.003) and occurred within 10 min of proning. There were no effects on end-tidal CO[SUB]2[/SUB], respiratory rate or heart rate. There was an increase in subjective discomfort (p=0.003), with no difference in breathlessness. Among healthy controls undergoing hypoxic challenge, proning did not lead to a change in SpO[SUB]2[/SUB] or subjective symptom scores.
Conclusion: Identification of suitable patients with COVID-19 requiring oxygen supplementation from general ward environments for awake proning is challenging. Prone positioning leads to a small increase in SpO[SUB]2[/SUB] within 10 min of proning though is associated with increased discomfort.
. 2021 Feb 7;8(1):00524-2021.
doi: 10.1183/23120541.00524-2021. eCollection 2022 Jan.
Physiological effects and subjective tolerability of prone positioning in COVID-19 and healthy hypoxic challenge
Akhilesh Jha[SUP] 1 2 3 [/SUP], Fangyue Chen[SUP] 2 3 [/SUP], Sam Mann[SUP] 4 [/SUP], Ravi Shah[SUP] 2 [/SUP], Randa Abu-Youssef[SUP] 1 [/SUP], Holly Pavey[SUP] 1 [/SUP], Helen Lin-Jia-Qi[SUP] 4 [/SUP], Josh Cara[SUP] 4 [/SUP], Daniel Cunningham[SUP] 5 [/SUP], Kate Fitzpatrick[SUP] 4 [/SUP], Celine Goh[SUP] 4 [/SUP], Renee Ma[SUP] 4 [/SUP], Souradip Mookerjee[SUP] 4 [/SUP], Vaitehi Nageshwaran[SUP] 2 [/SUP], Timothy Old[SUP] 2 [/SUP], Catherine Oxley[SUP] 4 [/SUP], Louise Jordon[SUP] 2 [/SUP], Mayurun Selvan[SUP] 2 [/SUP], Anna Wood[SUP] 4 [/SUP], Andrew Ying[SUP] 4 [/SUP], Chen Zhang[SUP] 4 [/SUP], Dariusz Wozniak[SUP] 6 [/SUP], Iain Goodhart[SUP] 5 [/SUP], Frances Early[SUP] 2 [/SUP], Marie Fisk[SUP] 1 2 [/SUP], Jonathan Fuld[SUP] 2 [/SUP]
Affiliations
- PMID: 35136823
- PMCID: PMC8591389
- DOI: 10.1183/23120541.00524-2021
Abstract
Background: Prone positioning has a beneficial role in coronavirus disease 2019 (COVID-19) patients receiving ventilation but lacks evidence in awake non-ventilated patients, with most studies being retrospective, lacking control populations and information on subjective tolerability.
Methods: We conducted a prospective, single-centre study of prone positioning in awake non-ventilated patients with COVID-19 and non-COVID-19 pneumonia. The primary outcome was change in peripheral oxygenation in prone versus supine position. Secondary outcomes assessed effects on end-tidal CO[SUB]2[/SUB], respiratory rate, heart rate and subjective symptoms. We also recruited healthy volunteers to undergo proning during hypoxic challenge.
Results: 238 hospitalised patients with pneumonia were screened; 55 were eligible with 25 COVID-19 patients and three non-COVID-19 patients agreeing to undergo proning - the latter insufficient for further analysis. 10 healthy control volunteers underwent hypoxic challenge. Patients with COVID-19 had a median age of 64 years (interquartile range 53-75). Proning led to an increase in oxygen saturation measured by pulse oximetry (SpO[SUB]2[/SUB]) compared to supine position (difference +1.62%; p=0.003) and occurred within 10 min of proning. There were no effects on end-tidal CO[SUB]2[/SUB], respiratory rate or heart rate. There was an increase in subjective discomfort (p=0.003), with no difference in breathlessness. Among healthy controls undergoing hypoxic challenge, proning did not lead to a change in SpO[SUB]2[/SUB] or subjective symptom scores.
Conclusion: Identification of suitable patients with COVID-19 requiring oxygen supplementation from general ward environments for awake proning is challenging. Prone positioning leads to a small increase in SpO[SUB]2[/SUB] within 10 min of proning though is associated with increased discomfort.