Awake prone positioning versus non invasive ventilation for COVID-19 patients with acute hypoxemic respiratory failure
ABSTRACTBackground: Oxygenation failure one of the main covid-19 presentation in pandemic. Prone position (PP) and non-invasive ventilation (NIV) have been traditionally used in acute respiratory distress syndrome (ARDS) to improve oxygenation and avoiding invasive ventilation complications. Awake p...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2021-01-01
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| Series: | Egyptian Journal of Anaesthesia |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/11101849.2021.1889944 |
| _version_ | 1827816513641381888 |
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| author | Gad S. Gad |
| author_facet | Gad S. Gad |
| author_sort | Gad S. Gad |
| collection | DOAJ |
| description | ABSTRACTBackground: Oxygenation failure one of the main covid-19 presentation in pandemic. Prone position (PP) and non-invasive ventilation (NIV) have been traditionally used in acute respiratory distress syndrome (ARDS) to improve oxygenation and avoiding invasive ventilation complications. Awake proning and noninvasive ventilation are being used as a therapy in COVID-19 hypoxic failure to improve outcomes.Methods: A prospective study of 30 COVID patients admitted in our Hospital critical care isolation. Co-operative hemodynamically stable patients, SaO2 ˂90%, PaO2/FiO2 ˂200, respiratory rate ˃ 24, bilateral lung infiltration on CT chest into two groups (15 pts in each) Oxygen was administered through non-rebreathing mask(NRB) mask O210-15 L/min with awake PP or NIV for 1-2 h each session, 3 h apart during waking hours for the first 3 days. Primary target improve oxygenation (SaO2 > 95% and P/f > 200 mm Hg), avoid intubation. ICU days and hospital stay are the secondary end points. Other COVID therapies were used according to our hospital protocol.Results: The mean SaO2 at admission 79 ± 8.47% in PP, 82 ± 7.05% in NIV, after PP or NIV applying the mean saO2 and paO2 was significantly increased (mean SaO2 93 ± 5.9%, mean PaO2 107 ± 12 mmHg)PP, (mean sop2 95 ± 4.2%, mean PaO2 129 ± 11 mmHg) NIV, the mean pacO2 was decreased significantly in NIV (39.34 ± 5.12 mmHg) compare to PP (43.41 ± 3.2 mmHg) p value ˂0.001 with no significant results regarding the PH (7.40 ± 0.02&7PP group .33 ± 0.06 NIV group), ICU mortality 20% in each group in whom need intubation, with no significant value in ICU or hospital stay .Conclusion: Awake prone positioning and non-invasive ventilation showed marked improvement in SaO2 and PaO2 in COVID-19 patients with improvement in clinical symptoms with reduced rate of intubation with superiority of NIV in hypercapnic patients. |
| first_indexed | 2024-03-12T00:20:40Z |
| format | Article |
| id | doaj.art-dcc16079cc36447ea3ed24584ade6fe6 |
| institution | Directory Open Access Journal |
| issn | 1110-1849 |
| language | English |
| last_indexed | 2024-03-12T00:20:40Z |
| publishDate | 2021-01-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Egyptian Journal of Anaesthesia |
| spelling | doaj.art-dcc16079cc36447ea3ed24584ade6fe62023-09-15T13:38:33ZengTaylor & Francis GroupEgyptian Journal of Anaesthesia1110-18492021-01-01371859010.1080/11101849.2021.1889944Awake prone positioning versus non invasive ventilation for COVID-19 patients with acute hypoxemic respiratory failureGad S. Gad0Department of Anesthesia, ICU & pain Management, School of Medicine, South Valley University, Qena, EgyptABSTRACTBackground: Oxygenation failure one of the main covid-19 presentation in pandemic. Prone position (PP) and non-invasive ventilation (NIV) have been traditionally used in acute respiratory distress syndrome (ARDS) to improve oxygenation and avoiding invasive ventilation complications. Awake proning and noninvasive ventilation are being used as a therapy in COVID-19 hypoxic failure to improve outcomes.Methods: A prospective study of 30 COVID patients admitted in our Hospital critical care isolation. Co-operative hemodynamically stable patients, SaO2 ˂90%, PaO2/FiO2 ˂200, respiratory rate ˃ 24, bilateral lung infiltration on CT chest into two groups (15 pts in each) Oxygen was administered through non-rebreathing mask(NRB) mask O210-15 L/min with awake PP or NIV for 1-2 h each session, 3 h apart during waking hours for the first 3 days. Primary target improve oxygenation (SaO2 > 95% and P/f > 200 mm Hg), avoid intubation. ICU days and hospital stay are the secondary end points. Other COVID therapies were used according to our hospital protocol.Results: The mean SaO2 at admission 79 ± 8.47% in PP, 82 ± 7.05% in NIV, after PP or NIV applying the mean saO2 and paO2 was significantly increased (mean SaO2 93 ± 5.9%, mean PaO2 107 ± 12 mmHg)PP, (mean sop2 95 ± 4.2%, mean PaO2 129 ± 11 mmHg) NIV, the mean pacO2 was decreased significantly in NIV (39.34 ± 5.12 mmHg) compare to PP (43.41 ± 3.2 mmHg) p value ˂0.001 with no significant results regarding the PH (7.40 ± 0.02&7PP group .33 ± 0.06 NIV group), ICU mortality 20% in each group in whom need intubation, with no significant value in ICU or hospital stay .Conclusion: Awake prone positioning and non-invasive ventilation showed marked improvement in SaO2 and PaO2 in COVID-19 patients with improvement in clinical symptoms with reduced rate of intubation with superiority of NIV in hypercapnic patients.https://www.tandfonline.com/doi/10.1080/11101849.2021.1889944Awake prone positionnon-invasive ventilationhypoxemia COVID-19SARS-CoV-2 |
| spellingShingle | Gad S. Gad Awake prone positioning versus non invasive ventilation for COVID-19 patients with acute hypoxemic respiratory failure Egyptian Journal of Anaesthesia Awake prone position non-invasive ventilation hypoxemia COVID-19 SARS-CoV-2 |
| title | Awake prone positioning versus non invasive ventilation for COVID-19 patients with acute hypoxemic respiratory failure |
| title_full | Awake prone positioning versus non invasive ventilation for COVID-19 patients with acute hypoxemic respiratory failure |
| title_fullStr | Awake prone positioning versus non invasive ventilation for COVID-19 patients with acute hypoxemic respiratory failure |
| title_full_unstemmed | Awake prone positioning versus non invasive ventilation for COVID-19 patients with acute hypoxemic respiratory failure |
| title_short | Awake prone positioning versus non invasive ventilation for COVID-19 patients with acute hypoxemic respiratory failure |
| title_sort | awake prone positioning versus non invasive ventilation for covid 19 patients with acute hypoxemic respiratory failure |
| topic | Awake prone position non-invasive ventilation hypoxemia COVID-19 SARS-CoV-2 |
| url | https://www.tandfonline.com/doi/10.1080/11101849.2021.1889944 |
| work_keys_str_mv | AT gadsgad awakepronepositioningversusnoninvasiveventilationforcovid19patientswithacutehypoxemicrespiratoryfailure |