CMAAO Coronavirus Facts and Myth Buster: Proning |
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CMAAO Coronavirus Facts and Myth Buster: Proning
Dr KK Aggarwal,  23 June 2020
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With inputs from Dr Monica Vasudev

9532: Proning May Avoid Intubation in Awake COVID Patients

Moving awake, non-intubated COVID-19 patients with hypoxemic respiratory failure from a supine to a prone position may reduce the odds of need of a ventilator. A small study of 29 patients suggested that those willing to assume a prone position for at least an hour, had improved oxygenation and were less likely to be intubated. The results were published in JAMA Internal Medicine.

If, after one hour, they reached >95% oxygenation, the rate of intubation was found to be decreased by 46%. One big caveat; however, is that the patient needs to have intact mental status.

Dr. Jelic and colleagues asked 29 patients with oxyhemoglobin saturation (SpO2) of <93% to participate in a test of the technique by lying on their bellies for as long as possible up to 24 hours daily. All patients were being given supplemental oxygen via nasal cannula and nonrebreather mask.

Four patients did not agree and were immediately intubated. The 25 who assumed the prone position had improved SpO2 compared to baseline. The improvements ranged from 1% to 34%. One hour after patients adopted prone position, 19 had SpO2 of >95%. Seven of these patients subsequently required intubation. Among the six patients with SpO2 <95%, five were intubated.

Among the 12 patients requiring intubation, three died in the ICU later. Of the 13 patients who did not require intubation, nine recovered and were discharged, two were transferred to the medical ward and two were in the step-down unit at the time of data analysis. (Reuters Health)

Dr KK Aggarwal

President CMAAO

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