Abstract

 
Background:
Before the COVID-19 pandemic, few studies speculated that early initiation of proning position in combination with NIV increases the probability of improved oxygenation in patients with ARDS. We conducted an observational study to look at the beneficial effect of proning position combined with NIV in awake, non‐intubated ICU/HDU patients presented with COVID-19-associated ARDS and Pneumonia.
Methods:
We studied 120 COVID-19-positive patients admitted to ICU/HDU, F.J Chest Hospital Quetta Pakistan. They were subjected to PP combined NIV and observed for 4 weeks duration for the primary outcome of improvement in SpO2 and PaO2/FiO2 (P/F) ratio. Data for secondary outcomes like intubation rate, median stay in hospital, and mortality rate were also noted.
Results:
The study included 68% male and 32% female patients with a median age of 60 years (IQR-18-80). After initiation of the standard PP, in 80% of 120 subjects, the SpO2 values improved from a median of 70% (IQR 60- 80) to a median of 93% (IQR 89-97), and the P/F ratio from 100 (IQR 77-123) to 150 (IQR 123-177) within median 6 days (IQR 2-8) of admission. PP was adopted for a median of 12 hours/24 hours (IQR 4-16), and 90% were applied NIV for 12 hours/24 hours (IQR 6-18) with a median of 12 days (IQR 7-28). The mortality rate was 27% and 18% were intubated for invasive ventilators. Total hospital stay was 16 days (median - IQR 10-28).
Conclusions:
Early awake self‐proning combined with NIV application demonstrated improved oxygen saturation (SpO2 & P/F ratio) and avoided intubation in our COVID-19-related ARDS/Pneumonia.
Key Words; Covid19; Proning Position; Non Invasive Ventilation; Hypoxia; ARDS; Pneumonia