Awake Proning in COVID-19 Patients With Hypoxemic Respiratory Failure

Awake Proning in Patients With COVID-19-Induced Acute Hypoxemic Respiratory Failure

The purpose of this study is to retrospectively review clinical data to determine whether awake proning improves oxygenation in spontaneously breathing patients with COVID-19 severe hypoxemic respiratory failure.

Critically ill patients with coronavirus disease 2019 (COVID-19) severely strained intensive care resources in New York in April 2020. The prone position improves oxygenation in intubated patients with acute respiratory distress syndrome. The investigators wanted to study whether the prone position is associated with improved oxygenation and decreased risk for intubation in spontaneously breathing patients with severe COVID-19 hypoxemic respiratory failure. Awake prone positioning was implemented based on the health care provider decision.

Inclusion Criteria:

• Consecutive patients admitted to the Columbia University step-down unit from April 6, 2020.
• Laboratory confirmed COVID-19 infection with severe hypoxemic respiratory failure defined as respiratory rate ≥30 breaths/min and oxyhemoglobin saturation (SpO2) ≤93% while receiving supplemental oxygen 6 L/min via nasal cannula and 15 L/min via non-rebreather facemask.

Exclusion Criteria:

• Altered mental status with inability to turn in bed without assistance
• Extreme respiratory distress requiring immediate intubation, or oxygen requirements less than specified in the inclusion criteria.