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‘Awake proning’ associated with improved COVID-19 clinical outcomes

15/09/2020

A study by Oxford respiratory researchers has found that putting COVID-19 patients in a prone position can lead to improved outcomes.

The findings of this retrospective study, supported by the NIHR Oxford Biomedical Research Centre, were published in an article by BMJ Open Respiratory Research.

Outcomes for patients with COVID-19 who require mechanical ventilation are often poor. Clinicians know that awake proning in COVID-19 can improve oxygenation, but clinical data has been limited. 

This retrospective study conducted at Oxford University Hospitals (OUH) NHS Foundation Trust aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure, or 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 the 71 patients managed on the respiratory HDU, with 48 (67.6%) required respiratory support. Patients managed with CPAP alone were significantly less likely to die than patients who required transfer onto HFNO. The mortality rate for CPAP was 36.4%, while the figure for HFNO was 69.2%.

The paper concludes: “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.”