Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan;38(2):375-379.
doi: 10.12669/pjms.38.ICON-2022.5772.

Combining Non-invasive Ventilation with timed position change in the Emergency Department to improve oxygenation and outcomes in patients with COVID-19: A prospective analysis from a low resource setup

Saima Ali  1 , Adeel Khatri  2 , Nida Ghouri  3 , Sama Mukhtar  4 , Suha Zawawi  5 , Syed Ghazanfar Saleem  6
Affiliations

Combining Non-invasive Ventilation with timed position change in the Emergency Department to improve oxygenation and outcomes in patients with COVID-19: A prospective analysis from a low resource setup

Saima Ali et al. Pak J Med Sci. 2022 Jan.

Abstract

Background: Moving away from invasive ventilation towards timed position change and non-invasive ventilation is especially of benefit in low and middle income countries, where judicious use of the available healthcare resources is the need of the day. Our study was conducted prospectively to develop strategies for non-invasive ventilation in combination with timed position change of patients to see its impact on their outcome.

Objectives: Non-invasive ventilation has proven to be of benefit in COVID-19 related acute lung injury. The objective of this prospective, cross sectional study was to develop a protocol for the use of non-invasive ventilation with timed position change to improve COVID-19 patients' outcomes in the Emergency Department (ED).

Methods: All patients presenting with confirmed or suspected COVID-19 were enrolled in the study from March 2020 to October 2020. Data was collected to see the effect of timed position change and non-invasive ventilation on these patients and its effect on delaying or avoiding invasive ventilation.

Results: Of the 207 COVID-19 patients presenting to the IHHN ED, 109(52.7%) had oxygen saturation in the nineties in supine position followed by right lateral in 37(17.9%), sitting up in 30(14.5%), left lateral in 29(14%) and prone position in 2(1%). Maximal oxygenation was achieved with non rebreather mask (NRM) and nasal prongs in 87(42%) of the patients, followed by the use of continuous positive airway pressure (CPAP) in 29(14%).

Conclusion: Most of the patients preferred to stay in the supine position and described it as the position of comfort. When used in combination supine position, patients on NRM with nasal prongs and on CPAP, had oxygen saturation in the nineties. Central obesity was found to be the prime reason for the inability to prone our patients. This needs to be followed up in the current fourth wave of COVID-19 to see the effectiveness of the said modalities.

Keywords: ARDS; COVID-19; Non-Invasive Ventilation; Prone Position; Supine Position.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: The authors have no funding and no conflict of interest to declare.

Similar articles

See all similar articles

Cited by

  • Awake prone positioning in acute hypoxaemic respiratory failure.
    McNicholas BA, Ibarra-Estrada M, Perez Y, Li J, Pavlov I, Kharat A, Vines DL, Roca O, Cosgrave D, Guerin C, Ehrmann S, Laffey JG. McNicholas BA, et al. Eur Respir Rev. 2023 May 3;32(168):220245. doi: 10.1183/16000617.0245-2022. Print 2023 Jun 30. Eur Respir Rev. 2023. PMID: 37137508 Free PMC article. Review.

References

    1. Ji Y, Ma Z, Peppelenbosch MP, Pan Q. Potential association between COVID-19 mortality and health-care resource availability. Lancet Glob Health. 2020;8(4):e480. doi:10.1016/S2214-109X(20)30068-1. - PMC - PubMed
    1. Alsaghir AH, Martin CM. Effect of prone positioning in patients with acute respiratory distress syndrome:a meta-analysis. Crit Care Med. 2008;36(2):603–609. doi:10.1097/01.CCM.0000299739.98236.05. - PubMed
    1. Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. JAMA. 2020;323(15):1499–1500. doi:10.1001/jama.2020.3633. - PubMed
    1. Bamford P, Bentley A, Dean J, Whitmore D, Wilson-Baig N. ICS guidance for prone positioning of the conscious COVID patient 2020. J Intensive Care Soc. 2020. Avaiable at: https://emcrit.org/wp-content/uploads/2020/04/2020-04-12-Guidance-for-co... .
    1. Padrão EM, Valente FS, Besen BA, Rahhal H, Mesquita PS, de Alencar JC, et al. Awake prone positioning in COVID-19 hypoxemic respiratory failure:exploratory findings in a single-center retrospective cohort study. J Acad Emerg Med. 2020;27(12):1249–1259. doi:10.1111/acem.14160. - PubMed

LinkOut - more resources