COVID-19 Management

Early Self-Proning of COVID-19 Patients in the ED Improves Oxygen Saturation

BACKGROUND AND PURPOSE:

Proning is standard care when treating patients with ARDS who cannot achieve adequate oxygen saturation
Caputo et al. (Academic Emergency Medicine 2020) describe the use of early proning of awake, non-intubated, suspected COVID-19 patients in the emergency department (ED)

Pilot study
Setting
- A single ED in New York City
Participants
- Patients who arrived at the ED with hypoxia (SpO2 <90%) and could self-prone
- Hypoxia did not resolve (SpO2 >93%) despite supplemental oxygen
Study design
- Patients asked to self-prone and change position
- SpO2 was measured with a standard pulse oximeter and recorded at triage and after 5 minutes of proning
- Supplemental oxygenation was in the form of non-rebreather mask (NRB) and nasal cannula
Primary outcome
- Change in SpO2 prior to proning, after application of supplemental oxygen and after 5 minutes of proning
Secondary outcome
- Intubation rate within 24 hours of arriving to the ED

50 patients
- All tested positive for SARS-CoV-2
- Median age: 59 years | 60% male
- 80% tachypneic on arrival (respiratory rate >20)
Median SpO2
- At triage: 80% (IQR 69 to 85)
- After supplemental oxygen: 84% (IQR 75 to 90)
- After 5 min of proning: 94% (IQR 90 to 95)
Comparing pre to post-proning, SpO2 was significantly increased (p=0.001)
24% of patients (13 patients) failed to improve or maintain their oxygen saturations and required endotracheal intubation within 24 hours of arrival to the ED

For COVID-19 patients in the ED, early self-proning while awake demonstrated improved oxygen saturation
Further research is necessary to determine overall impact on disease course and mortality rates

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