Effects of Awake Prone Positioning in Non-intubated Spontaneously Breathing COVID-19 Patients Requiring High Flow Oxygen Therapy in High Dependency Unit (HDU): An Observational Study.

Background and aims: Prone positioning increases oxygenation by recruiting dorsal lung regions and draining airway secretions and improves gas exchange and survival in ARDS. We describe the efficacy of prone positioning in awake non-intubated spontaneously breathing COVID-19 positive patients with hypoxemic acute respiratory failure.

Methods: We studied 26 awake non-intubated spontaneously breathing patients with hypoxemic respiratory failure treated with prone positioning. Patients were kept in prone position for two hours in each session and four such sessions were given to patients in 24 hours. SPO2, PaO, 2RR and haemodynamics were measured before prone positioning (PRE), 60 minutes of prone positioning (PRONE), and one hour after the completion of each session (POST).

Results: 26 patients (12 males and 14 females) non-intubated spontaneously breathing with SPO2 <94% on 0.4 FiO2 were treated with prone positioning. One patient required intubation and was shifted to ICU, the rest (25 patients) were discharged from HDU. Mean hours of prone positioning were 19.4 ± 2.06 hr. There was significant improvement in oxygenation (increase in PaO2 from 53.15 ± 6.0 mmHg to 64.23 ± 6.96 mmHg in PRE and POST sessions respectively, likewise there was increase in SPO2). No complications were noted with various sessions.

Conclusion: Prone positioning was feasible and improved oxygenation in awake non-intubated, spontaneously breathing COVID-19 patients with hypoxemic acute respiratory failure.