Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience

• Published in: BMJ open respiratory research Vol. 7; no. 1; p. e000678
• Main Authors: Hallifax, Rob J, Porter, Benedict ML, Elder, Patrick JD, Evans, Sarah B, Turnbull, Chris D, Hynes, Gareth, Lardner, Rachel, Archer, Kirsty, Bettinson, Henry V, Nickol, Annabel H, Flight, William G, Chapman, Stephen J, Hardinge, Maxine, Hoyles, Rachel K, Saunders, Peter, Sykes, Anny, Wrightson, John M, Moore, Alastair, Ho, Ling-Pei, Fraser, Emily, Pavord, Ian D, Talbot, Nicholas P, Bafadhel, Mona, Petousi, Nayia, Rahman, Najib M
• Format: Journal Article
• Language: English
• Published: England British Thoracic Society 01.09.2020; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Aged; Aged, 80 and over; Betacoronavirus; Body mass index; Chronic obstructive pulmonary disease; Continuous positive airway pressure; Continuous Positive Airway Pressure - methods; Coronavirus Infections - mortality; Coronavirus Infections - therapy; COVID-19; Diabetes; Disease Progression; Emergency medical care; Female; Frailty; Humans; Hypertension; Hypoxia; Intensive care; Intubation; Kidney diseases; Lung diseases; Male; Middle Aged; Mortality; Non-Invasive Ventilation; Noninvasive Ventilation - methods; Odds Ratio; Oxygen Inhalation Therapy - methods; Pandemics; Patient Positioning - methods; Patients; Pneumonia, Viral - mortality; Pneumonia, Viral - therapy; Prone Position; Regression analysis; Respiratory failure; respiratory infection; Retrospective Studies; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Treatment Outcome; United Kingdom; Ventilators; viral infection; Wakefulness; United Kingdom; non invasive ventilation; viral infection; respiratory infection
• ISSN: 2052-4439; 2052-4439
• DOI: 10.1136/bmjresp-2020-000678

The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.