|Title:||Awake Proning: Turning the table on COVID-19|
|Author(s):||S Toland R McGuinness, M Casey RW Costello NG McElvaney C Gunaratnam P Branagan K Hurley E O’Brien R Morgan B McNicholas I Sulaiman|
|Poster:||Click to view poster|
|Abstract:||One of the few evidence based treatments for Acute Respiratory Distress (ARDS) is prone position ventilation which has proven to reduce mortality in patients receiving mechanical ventilation(MV). It promotes lung homogeneity, improves gas exchange and respiratory mechanics. One of the hallmark features of severe SARS CoV2 is ARDS where patients can be oxygenated by MV or by awake non-invasive ventilation(NIV). It is not clear if awake proning in patients on NIV is as effective in SARS CoV2.|
This retrospective multi-centre study assessed all patients admitted with confirmed COVID-19 who were placed in awake prone position. 65 patients were identified across 7 centres. Co-morbidites, medications, vital signs and oxygen requirements on admission were documented. Data was analysed pre and post proning. Outcomes included endotracheal intubation and death.
Of the 65 patients, 44 were male (67.7%) with a median age of 54 (IQR 44-65). Thirty patients (46.1%) were on general wards, 30 (46.1%) in ICU and 5 (7.69%) in HDU. Within the whole cohort only 9 (13.63%) did not tolerate awake proning. The median time spent proning was 4 (IQR 2-8.75) hours. The mean S/F ratio pre-proning was 211, 217 1 hour post proning and 239 post proning. With regards to outcomes, only 19 patients (28.79%) required endotracheal intubation and 4 (6%) patients died.
Awake proning is a non-invasive tool that physiologically promotes gas exchange thushelping avoid intubation and MV in SARS CoV2.