Physiological effects and subjective tolerability of prone positioning in COVID-19 and healthy hypoxic challenge
Copyright ©The authors 2022..
BACKGROUND: Prone positioning has a beneficial role in coronavirus disease 2019 (COVID-19) patients receiving ventilation but lacks evidence in awake non-ventilated patients, with most studies being retrospective, lacking control populations and information on subjective tolerability.
METHODS: We conducted a prospective, single-centre study of prone positioning in awake non-ventilated patients with COVID-19 and non-COVID-19 pneumonia. The primary outcome was change in peripheral oxygenation in prone versus supine position. Secondary outcomes assessed effects on end-tidal CO2, respiratory rate, heart rate and subjective symptoms. We also recruited healthy volunteers to undergo proning during hypoxic challenge.
RESULTS: 238 hospitalised patients with pneumonia were screened; 55 were eligible with 25 COVID-19 patients and three non-COVID-19 patients agreeing to undergo proning - the latter insufficient for further analysis. 10 healthy control volunteers underwent hypoxic challenge. Patients with COVID-19 had a median age of 64 years (interquartile range 53-75). Proning led to an increase in oxygen saturation measured by pulse oximetry (SpO2) compared to supine position (difference +1.62%; p=0.003) and occurred within 10 min of proning. There were no effects on end-tidal CO2, respiratory rate or heart rate. There was an increase in subjective discomfort (p=0.003), with no difference in breathlessness. Among healthy controls undergoing hypoxic challenge, proning did not lead to a change in SpO2 or subjective symptom scores.
CONCLUSION: Identification of suitable patients with COVID-19 requiring oxygen supplementation from general ward environments for awake proning is challenging. Prone positioning leads to a small increase in SpO2 within 10 min of proning though is associated with increased discomfort.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
ERJ open research - 8(2022), 1 vom: 01. Jan. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Jha, Akhilesh [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Revised 01.05.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1183/23120541.00524-2021 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Jha, Akhilesh |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Physiological effects and subjective tolerability of prone positioning in COVID-19 and healthy hypoxic challenge |
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| 500 | |a Date Revised 01.05.2022 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Copyright ©The authors 2022. | ||
| 520 | |a BACKGROUND: Prone positioning has a beneficial role in coronavirus disease 2019 (COVID-19) patients receiving ventilation but lacks evidence in awake non-ventilated patients, with most studies being retrospective, lacking control populations and information on subjective tolerability | ||
| 520 | |a METHODS: We conducted a prospective, single-centre study of prone positioning in awake non-ventilated patients with COVID-19 and non-COVID-19 pneumonia. The primary outcome was change in peripheral oxygenation in prone versus supine position. Secondary outcomes assessed effects on end-tidal CO2, respiratory rate, heart rate and subjective symptoms. We also recruited healthy volunteers to undergo proning during hypoxic challenge | ||
| 520 | |a RESULTS: 238 hospitalised patients with pneumonia were screened; 55 were eligible with 25 COVID-19 patients and three non-COVID-19 patients agreeing to undergo proning - the latter insufficient for further analysis. 10 healthy control volunteers underwent hypoxic challenge. Patients with COVID-19 had a median age of 64 years (interquartile range 53-75). Proning led to an increase in oxygen saturation measured by pulse oximetry (SpO2) compared to supine position (difference +1.62%; p=0.003) and occurred within 10 min of proning. There were no effects on end-tidal CO2, respiratory rate or heart rate. There was an increase in subjective discomfort (p=0.003), with no difference in breathlessness. Among healthy controls undergoing hypoxic challenge, proning did not lead to a change in SpO2 or subjective symptom scores | ||
| 520 | |a CONCLUSION: Identification of suitable patients with COVID-19 requiring oxygen supplementation from general ward environments for awake proning is challenging. Prone positioning leads to a small increase in SpO2 within 10 min of proning though is associated with increased discomfort | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Chen, Fangyue |e verfasserin |4 aut | |
| 700 | 1 | |a Mann, Sam |e verfasserin |4 aut | |
| 700 | 1 | |a Shah, Ravi |e verfasserin |4 aut | |
| 700 | 1 | |a Abu-Youssef, Randa |e verfasserin |4 aut | |
| 700 | 1 | |a Pavey, Holly |e verfasserin |4 aut | |
| 700 | 1 | |a Lin-Jia-Qi, Helen |e verfasserin |4 aut | |
| 700 | 1 | |a Cara, Josh |e verfasserin |4 aut | |
| 700 | 1 | |a Cunningham, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Fitzpatrick, Kate |e verfasserin |4 aut | |
| 700 | 1 | |a Goh, Celine |e verfasserin |4 aut | |
| 700 | 1 | |a Ma, Renee |e verfasserin |4 aut | |
| 700 | 1 | |a Mookerjee, Souradip |e verfasserin |4 aut | |
| 700 | 1 | |a Nageshwaran, Vaitehi |e verfasserin |4 aut | |
| 700 | 1 | |a Old, Timothy |e verfasserin |4 aut | |
| 700 | 1 | |a Oxley, Catherine |e verfasserin |4 aut | |
| 700 | 1 | |a Jordon, Louise |e verfasserin |4 aut | |
| 700 | 1 | |a Selvan, Mayurun |e verfasserin |4 aut | |
| 700 | 1 | |a Wood, Anna |e verfasserin |4 aut | |
| 700 | 1 | |a Ying, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Chen |e verfasserin |4 aut | |
| 700 | 1 | |a Wozniak, Dariusz |e verfasserin |4 aut | |
| 700 | 1 | |a Goodhart, Iain |e verfasserin |4 aut | |
| 700 | 1 | |a Early, Frances |e verfasserin |4 aut | |
| 700 | 1 | |a Fisk, Marie |e verfasserin |4 aut | |
| 700 | 1 | |a Fuld, Jonathan |e verfasserin |4 aut | |
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