Self-Proning in COVID-19
Lauren M. Westafer, DO, MPH, MS
In this observational study, oxygen saturations in patients with COVID-19 increased after self-proning for 5 minutes.
Patients with severe COVID-19 often present with profound hypoxemia. Initial recommendations for their management included early intubation, but this was not predicated on evidence. Recently, many hospitals have initiated awake or self-proning protocols early in patients’ hospital courses, in an attempt to improve oxygenation and stave off intubation. Unlike the labor-intensive and risky proning procedure in patients with acute respiratory distress syndrome (in which patients are paralyzed, sedated, and rotated onto their stomachs), with self-proning, alert patients roll onto their stomachs or sides by themselves.
In this observational study, researchers in a New York City emergency department measured the change in oxygen saturation 5 minutes after self-proning in 50 patients with hypoxia and suspected (subsequently confirmed) COVID-19. Median oxygen saturation was 80% on arrival and increased to 84% after patients were placed on supplemental oxygen. After 5 minutes of proning, median oxygen saturation increased to 94%. Ultimately, 36% of patients were intubated within 72 hours and, of these, 38% (7) were intubated within the first hour.
In this small study, self-proning improved patients’ oxygenation at 5 minutes, but the duration of its effect is unclear. Notably, intubation was avoided in nearly two thirds of patients, adding support to the shift toward noninvasive modalities and self-proning in the initial management of patients with COVID-19 and significant hypoxemia, without respiratory distress. However, some of these patients will still require intubation during their hospital course, and so all of them should be monitored closely.
Caputo ND et al. Early self-proning in awake, non-intubated patients in the emergency department: A single ED’s experience during the COVID-19 pandemic. Acad Emerg Med 2020 Apr 22; [e-pub].
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