Effect of Early Awake Prone Positioning on Oxygen Saturation in Moderate to Severe COVID-19 Patients; A Retrospective Study

Abstract

SARS-CoV-2 has been classified as a pandemic by the World Health Organization. Respiratory problems are the most common complaint among those who have COVID-19, in ventilated individuals suffering from severe respiratory distress. The prone posture has historically been utilized to enhance oxygenation and reduce barotrauma. To see what would happen as an actual outcome treatment in COVID, awake proning is being tested for its potential to delay invasive ventilation while improving oxygenation and patient outcomes. As a net consequence, we performed a retrospective case study on non-intubated COVID-19 patients to see if awake proning with oxygen treatment was beneficial. Materials and methods: A retrospective observational study was conducted at Rajshahi Medical College Hospital, Rajshahi, Bangladesh from Nov 1 to Dec 31 2020. Our study included 75 patients (18 years or above) admitted with moderate and severe COVID-19 infection. Patients with hypoxemia (oxygen saturation <94%) or respiratory distress (≥30 breaths/min), or patients getting oxygen via Face Mask at 10L/min or Non-Rebreather Mask at 15L/mi were classified into the severe disease category. Patients were encouraged to continue different prone positions for 24 hours based on their comfort level and tolerance. Other COVID treatments were applied in accordance with the guidelines of the hospital. Results: The most common comorbid conditions were hypertension (78.61%), bronchial asthma (41.33%), and diabetes mellitus (40.00%). However, hypertension and more than one comorbidity (AOR -33.44, 95% CI 0.58 – 1912.87) are associated with increased mortality. The mean arterial oxygen saturation (SpO2) on admission was greater than 80%. P/f ratio in supine position was 86.47 ± 1.33 mm Hg before pronation and improved to 95.45 ± 1.53 mm Hg after pronation (p = 0.001). From the first to the fourteenth day, there was a noticeable difference. The average length of time spent was 14 days. Conclusion: Positioning patients awake and prone improved SpO2 and the P/f ratio significantly in the COVID-19 individuals diagnosed with improved clinical symptoms and reduced intubation rates.