Self-proning in COVID-19 patients on low-flow oxygen therapy. A cluster randomised controlled trial

Abstract

Introduction: Prone positioning as a complement to oxygen (O2) therapy to treat hypoxemia in COVID-19 pneumonia has been widely adopted even in non-severe patients, despite a lack of evidence. The aim of this single center cluster randomised trial is to test that an invitation to self-prone would decrease O2 needs in patients admitted to the ward for COVID-19 pneumonia on low-flow O2-therapy.

Methods: 27 patients with COVID-19 pneumonia admitted to our hospital were included in the study. 10 patients were randomised to self-proning and 17 to usual care.

Results: Oxygen needs assessed by O2 flow on nasal cannula at inclusion were similar between groups. Time from first symptoms to inclusion was 10.5±5.1 days. Estimated average time spend in prone-position was 295 min ± 216 min. 24hours after starting the intervention, the median O2 flow was 1.0 L/min (interquartile range (IQR), 0.1-2.9) in the prone position group and 2.0 L/min (IQR, 0.5-3.0) in the control group (P = 0.507). Median O2 saturation/fraction of inspired O2 ratio was 390 (IQR, 300-432) in the prone position group and 336 (IQR, 294-422) in the control group (P = 0.633). Self-proning was easy to implement and well tolerated. No serious side effect was reported.

Conclusions: Self-prone positioning in patients with COVID-19 pneumonia requiring low-flow O2-therapy resulted in a clinically meaningful reduction of O2 flow, but without reaching statistical significance. Early interruption of the trial probably resulted in underpower of our study. With the increase of COVID-19 cases, any simple intervention to limit the progression of hypoxemia and avoid transfers to ICUs may be of benefit for the management of hospital resources.