TY - JOUR T1 - Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience JF - BMJ Open Respiratory Research JO - BMJ Open Resp Res DO - 10.1136/bmjresp-2020-000678 VL - 7 IS - 1 SP - e000678 AU - Rob J Hallifax AU - Benedict ML Porter AU - Patrick JD Elder AU - Sarah B Evans AU - Chris D Turnbull AU - Gareth Hynes AU - Rachel Lardner AU - Kirsty Archer AU - Henry V Bettinson AU - Annabel H Nickol AU - William G Flight AU - Stephen J Chapman AU - Maxine Hardinge AU - Rachel K Hoyles AU - Peter Saunders AU - Anny Sykes AU - John M Wrightson AU - Alastair Moore AU - Ling-Pei Ho AU - Emily Fraser AU - Ian D Pavord AU - Nicholas P Talbot AU - Mona Bafadhel AU - Nayia Petousi AU - Najib M Rahman A2 - , Y1 - 2020/09/01 UR - http://bmjopenrespres.bmj.com/content/7/1/e000678.abstract N2 - 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. ER -