Authors (including presenting author) :
LO WPJ (1), YEUNG MW (1), Y CHAN (2), H CHEUNG (2), LI SC (1), LEE CH (1), LAM SM (1), KWAN YFE (1), SHUM HP (1)
Affiliation :
(1) Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital (2) Department of Occupational Therapy, Pamela Youde Nethersole Eastern Hospital
Introduction :
Prone positioning is an effective therapeutic intervention to promote gaseous exchange, alveolar recruitment and reduce patient mortality for those suffering from moderate to severe acute respiratory distress syndrome (ARDS). To prevent the development of ventilator-associated complications, non-intubated COVID-19 patients with type I respiratory failure were encouraged to lie in a prone position for as long as they can tolerate at an early stage of their disease.
Objectives :
To assess the feasibility, efficacy and safety of self-prone positioning in critically ill COVID-19 patients.
Methodology :
1. Education and bedside coaching were delivered to the frontline nurses about the dedicated nursing care and patient's monitoring during prolonged prone positioning. 2. Collaborated with the occupational therapists to design supporting devices that allowed the patient to prone without major complications, e.g. diaphragm limitation, nerve compression and pressure injuries. 3. Retrospectively compared the peripheral oxygen saturation(SpO2) and respiratory rate(RR) of the patients before and after prone positioning.
Result & Outcome :
Results: Starting from November to December 2020, 11(44%) out of 25 COVID-19 patients had adopted a self-prone position for more than 12 hours to promote oxygenation. 11(44%) patients could not tolerate prolonged prone positioning or could only lie in the lateral position. 3(12%) patients had been treated with mechanical ventilation since ICU admission. All patients who assumed prolonged self-prone position had a dramatic improvement in oxygen saturation(SpO2 raised from 3-9%, mean 5%) before and after positioning. The longer duration of the prone position, the better the oxygen saturation. The patients demonstrated less distress with the average respiratory rate lowered by 7 breaths per minute. Only two(18%) patients were subsequently intubated for mechanical ventilation but both were successfully extubated when their lung conditions improved. All patients were alert and were able to adjust their position during proning. Apart from neck pain, limb numbness, all of them(100%) were free from major complications associated with prone positions. Conclusions: The self-prone position is effective to improve the oxygenation of hypoxaemic patients of COVID-19. With close monitoring and dedicated nursing care, self-prone positioning could help improve patient outcomes and reduce the risk of invasive mechanical ventilation. Further studies are needed to explore the need for anxiolytic, sedative or pain medications to support patients to endure a longer period of self proning.
