Awake prone position in hypoxemic Covid 19 Pneumonia: Does it reduce the mortality rate?

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) is a pandemic respiratory infection that can worsen rapidly into an acute respiratory distress syndrome (ARDS) in some patients. Prone position is confirmed as a helpful treatment for ARDS within intubated patients. However, some studies have suggested its efficacy in awake patients with ARDS.

Aims: to evaluate the impact of awake prone position in patients with COVID-19 pneumonia, hospitalized outside the ICU, on mortality rate.

Methods: A prospective evaluative study between September 2020 and February 2021 including 139 confirmed covid-19 patients hospitalized in the pulmonology department of the military hospital of Tunis. Patients were randomly divided into two groups: G1:Prone position (n=38); G2: No Prone Position (n=101).

Result: The cohort included 139 patients. There was no difference between the two groups in sex ratio (2.1 vs 2.9), middle age (59.66 vs 62.49);and active smoking (24% vs 38%) respectively for G1 and G2.The most common comorbidities were: Hypertension (47 % vs 36 %), diabetes (15% vs 10%) and chronic obstructive pulmonary disease (0% vs 10%;p=0.04) respectively in G1 and G2. In G1 none of patients were transferred to ICU vs 12% in G2(p=0,033). Prone position patients were associated with decreased mortality rate 3% versus 22% (p=0,02).There were no significant difference between the two groups in main hospital length of stay (p=0.3).Middle arterial saturation of oxygen in supine position was 90% versus 94% in prone position(p<0.001).

Conclusion: Prone positioning was effective in decreasing mortality, arterial saturation of oxygen and transfer to ICU in awake patients with COVID-19 requiring oxygen supplementation.