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Critical care
Early conscious prone positioning in patients with COVID-19 receiving continuous positive airway pressure: a retrospective analysis
  1. Stuart Winearls1,
  2. Ema L Swingwood2,3,
  3. Charlotte L Hardaker2,
  4. Amy M Smith2,
  5. Fraser M Easton1,
  6. Katherine J Millington1,
  7. Rebecca S Hall2,
  8. Ann Smith3 and
  9. Katrina J Curtis1
  1. 1Department of Respiratory Medicine, Bristol Royal Infirmary, Bristol, UK
  2. 2Adult Therapy Services, Bristol Royal Infirmary, Bristol, UK
  3. 3Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
  1. Correspondence to Dr Katrina J Curtis; katrina.curtis{at}uhbw.nhs.uk

Abstract

The global pandemic of COVID-19 has challenged the management of hypoxaemic respiratory failure and strained intensive care unit resources. While prone positioning (PP) is an established therapy in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), its role in conscious patients is less well defined. We retrospectively reviewed our experience of implementing early PP in a cohort of 24 patients with acute hypoxaemic respiratory failure due to COVID-19 who required support with continuous positive airway pressure (CPAP). The use of PP alongside CPAP significantly increased both the ROX index and arterial oxygen pressure:fractional inspired oxygen (PaO2:FiO2) ratio from baseline values (ROX index: 7.0±2.5 baseline vs 11.4±3.7 CPAP+PP, p<0.0001; PaO2:FiO2 ratio: 143±73 mm Hg baseline vs 252±87 mm Hg CPAP+PP, p<0.01), and the changes to both the ROX index and PaO2:FiO2 ratio remained significant 1 hour after cessation of proning. The mean duration of PP in the first 24 hours was 8±5 hours. Few complications were observed and PP was continued for a mean of 10±5 days. From our experience in a dedicated COVID-19 respiratory high care unit, PP alongside CPAP therapy was feasible, tolerated, safe and improved oxygenation. The use of conscious PP in ARDS warrants further investigation in randomised controlled trials.

  • ARDS
  • viral infection
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2020-000711

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    Footnotes

    • SW and ELS contributed equally.

    • Contributors SW, ELS, FME, KJM and KJC conceived the study idea. Data collection and analysis was performed by SW, ELS, CLH, AMS, FME, KJM, RSH, AS and KJC. All authors provided intellectual interpretation of results and approval of the final manuscript. KJC acts as the guarantor for this manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the National Health Service or the Department of Health.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.