RT Journal Article
SR Electronic
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
FD British Thoracic Society
SP e000678
DO 10.1136/bmjresp-2020-000678
VO 7
IS 1
A1 Rob J Hallifax
A1 Benedict ML Porter
A1 Patrick JD Elder
A1 Sarah B Evans
A1 Chris D Turnbull
A1 Gareth Hynes
A1 Rachel Lardner
A1 Kirsty Archer
A1 Henry V Bettinson
A1 Annabel H Nickol
A1 William G Flight
A1 Stephen J Chapman
A1 Maxine Hardinge
A1 Rachel K Hoyles
A1 Peter Saunders
A1 Anny Sykes
A1 John M Wrightson
A1 Alastair Moore
A1 Ling-Pei Ho
A1 Emily Fraser
A1 Ian D Pavord
A1 Nicholas P Talbot
A1 Mona Bafadhel
A1 Nayia Petousi
A1 Najib M Rahman
A1 ,
YR 2020
UL http://bmjopenrespres.bmj.com/content/7/1/e000678.abstract
AB 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.