Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience

BMJ Open Respir Res. 2020 Sep;7(1):e000678. doi: 10.1136/bmjresp-2020-000678.

Abstract

The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.

Keywords: non invasive ventilation; respiratory infection; viral infection.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Betacoronavirus
  • COVID-19
  • Continuous Positive Airway Pressure / methods*
  • Coronavirus Infections / mortality
  • Coronavirus Infections / therapy*
  • Disease Progression
  • Female
  • Humans
  • Male
  • Middle Aged
  • Noninvasive Ventilation / methods
  • Odds Ratio
  • Oxygen Inhalation Therapy / methods*
  • Pandemics
  • Patient Positioning / methods*
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / therapy*
  • Prone Position*
  • Retrospective Studies
  • SARS-CoV-2
  • Treatment Outcome
  • United Kingdom
  • Wakefulness