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INTRODUCTION: Most of COVID-19 patients present with hypoxemic respiratory failure. Proning is one of the management options proven to improve oxygenation and reduce mortality in non-COVID-19-related acute respiratory distress syndrome. As a response to COVID-19 pandemic surge, a dedicated COVID-19 respiratory ward for the management of mild to moderate ARDS patients who require oxygen therapy, non-invasive ventilation (NIV), or high-flow nasal cannula (HFNC) was established. We adopted a policy of early awake proning in such patients. AIMS: To determine the physiological changes, improvement in oxygenation, the need for intubation, alongside with the duration, tolerance, and adverse effects of awake proning. STUDY DESIGN AND METHODS: Single-center, prospective observational cohort study. All awake, non-intubated, spontaneously breathing patients with COVID-19, and hypoxemic acute respiratory failure requiring oxygen supplementation, NIV, or HF RESULTS: Fifty patients were enrolled. There was a significant improvement in oxygenation when turning the patients from supine to prone position with mean PFR was 85 (SD 13.76) in supine position which increased to 124 (SD 34.08) in prone position with substantial increase in mean PFR 1-h post proning to 138 (SD 28.01) and P-value 0.0001. Prone positioning was feasible in 41 (82%) patients (mean duration 8.5 (SD 3.13) h), and 38 (76%) patients reported that it was well tolerated. CONCLUSION: Awake proning was feasible, tolerable, and effective in improving oxygenation in patients with COVID-19-related pneumonia and acute hypoxemic respiratory failure in this prospective study.
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BACKGROUND: Intensive care health care workers (HCWs) are frontlines of this crisis as they deal with critically ill COVID-19 patients which can potentially affect their mental well-being and causes different levels of stress. AIM: To determine the prevalence of stress among HCWs involved in the management of critically ill COVID-19 patient, identify the factors associated with stress, and highlight the availability of psychological support provided to HCWs. METHODS: A cross-sectional multicenter, international study using a web-based questionnaire of 27 questions including the Perceived Stress Scale-10 (PSS-10) for assessment of stress level. Questions to identify factors associated with stress, the psychological support provided, and the sociodemographic characteristics were included. RESULTS: We received a total 1649 responses from 59 countries: 550 (34%) were from Europe, 525 (32.36%) from Asia, 283 (17.44%) from Africa, 177 (11%) from America, and 88 (5.42%) from Australia. The average stress level was 22 points on the PSS denoting moderate stress in 1327 (81.8%) respondents, while 239 (14.73%) respondents had a severe level of stress. Female gender, working in high capacity units and remote areas in addition to lack of psychological support, was significantly associated with stress in our study. CONCLUSION: Stress level was moderate to severe among intensive care HCWs during this pandemic, and many factors were associated with stress emphasizing the importance of psychological support during that unprecedented pandemic.