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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