Conscious prone positioning during non-invasive ventilation in COVID-19 patients: experience from a single centre

Abstract

Critically ill patients admitted to hospital following SARS-CoV-2 infection often experience hypoxic respiratory failure and a proportion require invasive mechanical ventilation to maintain adequate oxygenation. The combination of prone positioning and non-invasive ventilation in conscious patients may have a role in improving oxygenation. The purpose of this study was to assess the effect of prone positioning in spontaneously ventilating patients receiving non-invasive ventilation admitted to the intensive care. Clinical data of 81 patients admitted with COVID 19 pneumonia and acute hypoxic respiratory failure were retrieved from electronic medical records and examined. Patients who had received prone positioning in combination with non-invasive ventilation were identified. A total of 20 patients received prone positioning in conjunction with non-invasive ventilation. This resulted in improved oxygenation as measured by a change in PaO ₂/FiO ₂ (P/F) ratio of 28.7 mmHg while prone, without significant change in heart rate or respiratory rate. Patients on average underwent 5 cycles with a median duration of 3 hours. There were no reported deaths, 7 of the 20 patients (35%) failed non-invasive ventilation and subsequently required intubation and mechanical ventilation. In our cohort of 20 COVID-19 patients with moderate acute hypoxic respiratory failure, prone positioning with non-invasive ventilation resulted in improved oxygenation. Prone positioning with non-invasive ventilation may be considered as an early therapeutic intervention in COVID-19 patients with moderate acute hypoxic respiratory failure.

Keywords: COVID-19; Intensive Care; Non-invasive ventilation; Prone.

Figure 1.. Time spent prone vs time spent supine (hours) for each patient throughout their admission.

Patients that failed non-invasive ventilation and required invasive mechanical ventilation (NIV+IMV group) are shown in blue and non-invasive ventilation (NIV) only group in red.

Figure 2.. Pictorial representation of changes in the PaO2/FiO2 ratio for each prone cycle from all patients.

Patients that failed non-invasive ventilation and required invasive mechanical ventilation (NIV+IMV group) are shown as blue dots and non-invasive ventilation (NIV) only group in red dots.