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COVID-19 Management

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

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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)

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

  • 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

Learn More – Primary Sources:

Early Self-Proning in Awake, Non-intubated Patients in the Emergency Department: A Single EDs Experience during the COVID-19 Pandemic

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Related ObG Topics:

What are the Strongest Predictors of COVID-19 Hospitalization and Critical Illness?
NIH COVID-19 Treatment Guidelines
ARDS, Critical Care and COVID-19: ‘Surviving Sepsis Campaign’ Guidelines and Key Points

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