Authors (including presenting author) :
Man MY (1), Lam SM(1), Shum HP(1), Li KC(1), Lau S(1), Ip HL (2),Yan WW (1)
Affiliation :
(1) Department of Intensive care, Pamela Youde Nethersole Eastern Hospital
(2) Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
Introduction :
Introduction
Significant ventilator-associated pneumonia and mortality were found in COVID-19 patients who required mechanical ventilation which calls for non-invasive means in managing respiratory failure.
In the first three waves of COVID-19 outbreak, the intubation rate was 65.5%, comparable to 61.3% among all COVID-19 patients admitted to other ICUs in Hong Kong. At our center, mechanical ventilation of COVID-19 patients was associated with a high incidence of VAP (23.8 vs 9.5 per 1000 ventilator days in non-COVID-19 patients; p=0.16) and a high mortality rate of 42.1%. Since the start of the fourth wave in end of November 2020, we seek to change the situation by adopting awake proning with high-flow oxygen therapy.
Objectives :
(1) To investigate 1-hour respiratory parameters after proning
(2) To investigate intubation rate and mortality in patients received awake proning
Methodology :
We retrospectively reviewed patients admitted to the ICU of Pamela Youde Nethersole Eastern Hospital (PYNEH) in Hong Kong with SARS-CoV-2 infection from 28th November to 15th December 2020. Patients’ laboratory, respiratory parameters and outcome data were recorded and analyzed.
Result & Outcome :
Eleven received prone ventilation. The median age was 67 (inter-quartile range IQR 59-72), and median COVID-19 GRAM score was 151 (IQR 133-181), representing a high-risk group. There were significant improvements one-hour after awake proning in SpO2 (95% vs 92%, p=0.008), FiO2 (0.4 vs 0.5, p=0.003), SpO2/FiO2 (240 vs 184, p=0.005), respiratory rate (19 vs 26, p=0.006), and ROX index (13.22 vs 7.67, p=0.003) (Table 1). Though not reaching statistical significance, the median PaO2, PaCO2 and PaO2/FiO2 improved after proning. Five patients are still under intensive care. The intubation rate is 16.7% (but up to 44% if all required intubation subsequently) and ICU mortality is 11.1% (but up to 38.9% if all remaining patients died), which is in contrast to 65.5% and 27.6% respectively in the first three waves.
Awake proning potentially minimizes complications from invasive ventilation and provides a low-cost low-risk treatment option in COVID-19 patients with respiratory failure. This is particularly important when healthcare resources are strained at times of a pandemic.
