132 CMAAO
CORONA FACTS and MYTH BUSTER Proning in COVID
Dr K K Aggarwal
President CMAAO
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
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