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 Hallifax, Rob J
A1 Porter, Benedict ML
A1 Elder, Patrick JD
A1 Evans, Sarah B
A1 Turnbull, Chris D
A1 Hynes, Gareth
A1 Lardner, Rachel
A1 Archer, Kirsty
A1 Bettinson, Henry V
A1 Nickol, Annabel H
A1 Flight, William G
A1 Chapman, Stephen J
A1 Hardinge, Maxine
A1 Hoyles, Rachel K
A1 Saunders, Peter
A1 Sykes, Anny
A1 Wrightson, John M
A1 Moore, Alastair
A1 Ho, Ling-Pei
A1 Fraser, Emily
A1 Pavord, Ian D
A1 Talbot, Nicholas P
A1 Bafadhel, Mona
A1 Petousi, Nayia
A1 Rahman, Najib M
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.