132 CMAAO CORONA FACTS and MYTH BUSTER Proning in COVID
Dr K K Aggarwal
With inputs from Dr Monica Vasudev
954: Proning May Avoid Intubation in Awake COVID Patients
Asking awake, non-intubated COVID-19 patients suffering from hypoxemic respiratory failure to move from a supine to a prone position may reduce the likelihood they will need a ventilator. In a small study of 29 patients, those who were willing to assume a prone position for at least one hour experienced improved oxygenation and a lower likelihood of being intubated, according to the results published in JAMA Internal Medicine.
If after one hour they reached 95% or more oxygenation, the rate of intubation was reduced by 46%.One big caveat is that the patient needs to have intact mental status."
Dr. Jelic and her colleagues asked 29 patients who had oxyhemoglobin saturation (Spo2) of 93% or less to participate in a test of the technique by lying on their bellies for as long as they could tolerate up to 24 hours daily. All of the patients were receiving supplemental oxygen via nasal cannula and nonrebreather mask.
Four patients refused and were immediately intubated. Among the 25 who assumed the prone position, Spo2 improved compared to baseline. The improvements ranged from 1% to 34%. One hour after patients rolled over onto their bellies, 19 had Spo2 of 95% or greater. Seven of those patients subsequently required intubation. Among the six patients whose Spo2 remained less than 95%, five were intubated.
Among the 12 patients who required intubation, three subsequently died in the ICU. Among the 13 patients who did not require intubation, nine recovered and were discharged from the hospital, two were transferred to the medical ward and two remained in the step-down unit at the time the data were analyzed. Reuters