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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.

 

Comment:
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.

 

Citation(s):

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].

(https://doi.org/10.1111/acem.13994)

 

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