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Conscious prone positioning during non-invasive ventilation in COVID-19 patients: experience from a single centre

Conscious prone positioning during non-invasive ventilation in COVID-19 patients: experience from a single centre
Conscious prone positioning during non-invasive ventilation in COVID-19 patients: experience from a single centre

Critically ill patients admitted to hospital following SARS-CoV-2 infection often experience hypoxic respiratory failure and a proportion require invasive mechanical ventilation to maintain adequate oxygenation. The combination of prone positioning and non-invasive ventilation in conscious patients may have a role in improving oxygenation. The purpose of this study was to assess the effect of prone positioning in spontaneously ventilating patients receiving non-invasive ventilation admitted to the intensive care. Clinical data of 81 patients admitted with COVID 19 pneumonia and acute hypoxic respiratory failure were retrieved from electronic medical records and examined. Patients who had received prone positioning in combination with non-invasive ventilation were identified. A total of 20 patients received prone positioning in conjunction with non-invasive ventilation. This resulted in improved oxygenation as measured by a change in PaO 2/FiO 2 (P/F) ratio of 28.7 mmHg while prone, without significant change in heart rate or respiratory rate. Patients on average underwent 5 cycles with a median duration of 3 hours. There were no reported deaths, 7 of the 20 patients (35%) failed non-invasive ventilation and subsequently required intubation and mechanical ventilation. In our cohort of 20 COVID-19 patients with moderate acute hypoxic respiratory failure, prone positioning with non-invasive ventilation resulted in improved oxygenation. Prone positioning with non-invasive ventilation may be considered as an early therapeutic intervention in COVID-19 patients with moderate acute hypoxic respiratory failure.

Betacoronavirus, Coronavirus Infections/therapy, Female, Humans, Male, Middle Aged, Noninvasive Ventilation, Pandemics, Patient Positioning, Pneumonia, Viral/therapy, Prone Position
2046-1402
Burton-Papp, Helmi C.
9b5974f5-b092-470e-9172-c048daf1b627
Jackson, Alexander I.R.
9bbcdd0e-a9c8-46d3-945c-53e9262c4f4c
Beecham, Ryan
f930648f-5bcb-4c56-ae34-61db6d54b251
Ferrari, Matteo
c31e1074-bdf3-47bb-915a-407add15e8ba
Nasim-Mohi, Myra
b720d2a1-2c26-4712-b16c-a8543bbe54fe
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Chambers, Robert
391d783f-43f0-4fdd-970f-36db9a90bf05
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
University Hospital Southampton Critical Care Team
REACT COVID Investigators
Burton-Papp, Helmi C.
9b5974f5-b092-470e-9172-c048daf1b627
Jackson, Alexander I.R.
9bbcdd0e-a9c8-46d3-945c-53e9262c4f4c
Beecham, Ryan
f930648f-5bcb-4c56-ae34-61db6d54b251
Ferrari, Matteo
c31e1074-bdf3-47bb-915a-407add15e8ba
Nasim-Mohi, Myra
b720d2a1-2c26-4712-b16c-a8543bbe54fe
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Chambers, Robert
391d783f-43f0-4fdd-970f-36db9a90bf05
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751

Burton-Papp, Helmi C., Jackson, Alexander I.R., Beecham, Ryan, Ferrari, Matteo, Nasim-Mohi, Myra, Grocott, Michael P.W., Chambers, Robert and Dushianthan, Ahilanandan , University Hospital Southampton Critical Care Team and REACT COVID Investigators (2020) Conscious prone positioning during non-invasive ventilation in COVID-19 patients: experience from a single centre. F1000 Research, 9, [859]. (doi:10.12688/f1000research.25384.1).

Record type: Article

Abstract

Critically ill patients admitted to hospital following SARS-CoV-2 infection often experience hypoxic respiratory failure and a proportion require invasive mechanical ventilation to maintain adequate oxygenation. The combination of prone positioning and non-invasive ventilation in conscious patients may have a role in improving oxygenation. The purpose of this study was to assess the effect of prone positioning in spontaneously ventilating patients receiving non-invasive ventilation admitted to the intensive care. Clinical data of 81 patients admitted with COVID 19 pneumonia and acute hypoxic respiratory failure were retrieved from electronic medical records and examined. Patients who had received prone positioning in combination with non-invasive ventilation were identified. A total of 20 patients received prone positioning in conjunction with non-invasive ventilation. This resulted in improved oxygenation as measured by a change in PaO 2/FiO 2 (P/F) ratio of 28.7 mmHg while prone, without significant change in heart rate or respiratory rate. Patients on average underwent 5 cycles with a median duration of 3 hours. There were no reported deaths, 7 of the 20 patients (35%) failed non-invasive ventilation and subsequently required intubation and mechanical ventilation. In our cohort of 20 COVID-19 patients with moderate acute hypoxic respiratory failure, prone positioning with non-invasive ventilation resulted in improved oxygenation. Prone positioning with non-invasive ventilation may be considered as an early therapeutic intervention in COVID-19 patients with moderate acute hypoxic respiratory failure.

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60b84222-f81f-43eb-bb9a-089c29cda259 25384 ahilanandan dushianthan - Version of Record
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e-pub ahead of print date: 31 July 2020
Additional Information: Copyright: © 2020 Burton-Papp HC et al.
Keywords: Betacoronavirus, Coronavirus Infections/therapy, Female, Humans, Male, Middle Aged, Noninvasive Ventilation, Pandemics, Patient Positioning, Pneumonia, Viral/therapy, Prone Position

Identifiers

Local EPrints ID: 444787
URI: http://eprints.soton.ac.uk/id/eprint/444787
ISSN: 2046-1402
PURE UUID: d811d93a-63cc-41cd-afc6-037f60c74fd1
ORCID for Alexander I.R. Jackson: ORCID iD orcid.org/0000-0002-3153-9231
ORCID for Michael P.W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581
ORCID for Ahilanandan Dushianthan: ORCID iD orcid.org/0000-0002-0165-3359

Catalogue record

Date deposited: 04 Nov 2020 17:33
Last modified: 28 Apr 2022 02:24

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Contributors

Author: Helmi C. Burton-Papp
Author: Alexander I.R. Jackson ORCID iD
Author: Ryan Beecham
Author: Matteo Ferrari
Author: Myra Nasim-Mohi
Author: Robert Chambers
Author: Ahilanandan Dushianthan ORCID iD
Corporate Author: University Hospital Southampton Critical Care Team
Corporate Author: REACT COVID Investigators

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