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. 2020 Sep 28;3(4):260-271.
doi: 10.1093/pcmedi/pbaa034. eCollection 2020 Dec.

Efficacy of early prone or lateral positioning in patients with severe COVID-19: a single-center prospective cohort

Zhong Ni  1 , Kaige Wang  1 , Ting Wang  1 , Yuenan Ni  1 , Wei Huang  2 , Ping Zhu  2 , Tao Fan  2 , Ye Wang  1 , Bo Wang  1 , Jun Deng  3 , Zhicheng Qian  4 , Jiasheng Liu  5 , Wenhao Cai  2 , Shanling Xu  6 , Yu Du  7 , Gang Wang  1 , Zongan Liang  1 , Weimin Li  1 , Jianfei Luo  5 , Fengming Luo  1 , Dan Liu  1
Affiliations

Efficacy of early prone or lateral positioning in patients with severe COVID-19: a single-center prospective cohort

Zhong Ni et al. Precis Clin Med. .

Abstract

Background: Position intervention has been shown to improve oxygenation, but its role in non-invasively ventilated patients with severe COVID-19 has not been assessed. The objective of this study was to investigate the efficacy of early position intervention on non-invasively ventilated patients with severe COVID-19.

Methods: This was a single-center, prospective observational study in consecutive patients with severe COVID-19 managed in a provisional ICU at Renmin Hospital of Wuhan University from 31 January to 15 February 2020. Patients with chest CT showing exudation or consolidation in bilateral peripheral and posterior parts of the lungs were included. Early position intervention (prone or lateral) was commenced for > 4 hours daily for 10 days in these patients, while others received standard care.

Results: The baseline parameters were comparable between the position intervention group (n = 17) and the standard care group (n = 35). Position intervention was well-tolerated and increased cumulative adjusted mean difference of SpO2/FiO2 (409, 95% CI 86 to 733) and ROX index (26, 95% CI 9 to 43) with decreased Borg scale (-9, 95% CI -15 to -3) during the first 7 days. It also facilitated absorption of lung lesions and reduced the proportion of patients with high National Early Warning Score 2 (≥ 7) on days 7 and 14, with a trend toward faster clinical improvement. Virus shedding and length of hospital stay were comparable between the two groups.

Conclusions: This study provides the first evidence for improved oxygenation and lung lesion absorption using early position intervention in non-invasively ventilated patients with severe COVID-19, and warrants further randomized trials.

Keywords: Borg scale; COVID-19; ROX index; early position intervention; oxygenation.

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Figures

Figure 1.
Figure 1.
Flow chart of patient inclusion.
Figure 2.
Figure 2.
Forest plots showing between-group mean difference of position intervention vs. standard care. (A) Pulse oximetry to fraction of inspired oxygen (SpO2/FiO2). (B) Respiratory rate-Oxygenation (ROX) index. (C) Borg scale. Data are expressed as mean (95% CI).
Figure 3.
Figure 3.
Chest CT score and changes before and after treatment. (A) Chest CT score. (B) Number of patients with lung lesion absorption > 30%. (C) Chest CT images of a 52-year-old patient with COVID-19: (i) Chest CT images obtained on 11 February 2020 show predominantly bilateral posterior consolidation. (ii) Chest CT images obtained on 20 February 2020 show the absorption of consolidation after prone position treatment from 13 February to 20 February 2020.
Figure 4.
Figure 4.
Time to clinical improvement.
See this image and copyright information in PMC

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