Physiological effects and subjective tolerability of prone positioning in COVID-19 and healthy hypoxic challenge.
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Authors
Chen, Fangyue
Mann, Sam
Abu-Youssef, Randa
Pavey, Holly
Cara, Josh
Cunningham, Daniel
Fitzpatrick, Kate
Goh, Celine
Ma, Renee
Nageshwaran, Vaitehi
Oxley, Catherine
Selvan, Mayurun
Ying, Andrew
Zhang, Chen
Wozniak, Dariusz
Goodhart, Iain
Early, Frances
Fisk, Marie
Fuld, Jonathan
Publication Date
2022-01Journal Title
ERJ Open Res
ISSN
2312-0541
Publisher
European Respiratory Society (ERS)
Volume
8
Issue
1
Language
eng
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Jha, A., Chen, F., Mann, S., Shah, R., Abu-Youssef, R., Pavey, H., Lin-Jia-Qi, H., et al. (2022). Physiological effects and subjective tolerability of prone positioning in COVID-19 and healthy hypoxic challenge.. ERJ Open Res, 8 (1) https://doi.org/10.1183/23120541.00524-2021
Abstract
BACKGROUND: Prone positioning has a beneficial role in coronavirus disease 2019 (COVID-19) patients receiving ventilation but lacks evidence in awake non-ventilated patients, with most studies being retrospective, lacking control populations and information on subjective tolerability. METHODS: We conducted a prospective, single-centre study of prone positioning in awake non-ventilated patients with COVID-19 and non-COVID-19 pneumonia. The primary outcome was change in peripheral oxygenation in prone versus supine position. Secondary outcomes assessed effects on end-tidal CO2, respiratory rate, heart rate and subjective symptoms. We also recruited healthy volunteers to undergo proning during hypoxic challenge. RESULTS: 238 hospitalised patients with pneumonia were screened; 55 were eligible with 25 COVID-19 patients and three non-COVID-19 patients agreeing to undergo proning - the latter insufficient for further analysis. 10 healthy control volunteers underwent hypoxic challenge. Patients with COVID-19 had a median age of 64 years (interquartile range 53-75). Proning led to an increase in oxygen saturation measured by pulse oximetry (SpO2) compared to supine position (difference +1.62%; p=0.003) and occurred within 10 min of proning. There were no effects on end-tidal CO2, respiratory rate or heart rate. There was an increase in subjective discomfort (p=0.003), with no difference in breathlessness. Among healthy controls undergoing hypoxic challenge, proning did not lead to a change in SpO2 or subjective symptom scores. CONCLUSION: Identification of suitable patients with COVID-19 requiring oxygen supplementation from general ward environments for awake proning is challenging. Prone positioning leads to a small increase in SpO2 within 10 min of proning though is associated with increased discomfort.
Sponsorship
National Institute for Health Research (NIHR) (ACF-2018-14-507)
Addenbrooke&apos (900249)
Identifiers
PMC8591389, 35136823
External DOI: https://doi.org/10.1183/23120541.00524-2021
This record's URL: https://www.repository.cam.ac.uk/handle/1810/334945
Rights
Attribution-NonCommercial 4.0 International
Licence URL: https://creativecommons.org/licenses/by-nc/4.0/
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