AWAKE PRONING: A FUTURE STANDARD OF CARE IN ACUTE RESPIRATORY DISEASES?

ABSTRACT

TYPE Case Report TOPIC Chest Infections INTRODUCTION: COVID19 leads to Acute Respiratory Failure (ARF) with dyspnea and respiratory exhaustion, ultimately progressing to Acute Respiratory Distress Syndrome (ARDS). The authors present a case of an awake proning/reposition (APR) strategy in a patient with COVID19-ARF. CASE PRESENTATION A 65-year-old man was admitted for severe COVID19 in February, 2021. At presentation, he was dyspneic on the 10th disease day, had mild hypoxemia and mild systemic inflammation. Immediately, dexamethasone 6mg qd, prophylactic anticoagulation and conventional oxygen therapy (COT) were started. In the first 48 hours, ARF kept worsening and increasing COT demand was needed. APR was started, leading to hypoxemia and polypnea improvement. The patient was ultimately transferred to the Intensive Care Unit (ICU), where non-invasive-ventilation (NIV) and APR were maintained for one week and invasive ventilation (IV) avoided. After twenty days of hospitalization, the patient was discharged without COT. DISCUSSION: Proning position (PP) is an already largely diffused strategy in ICU patients, which improves ARF and prevents ARDS and IV. Supine position leads to dorsal alveoli atelectasis by causing direct (compression) and indirect (over-inflation of ventral alveoli) pressure, which ultimately leads to V/Q mismatch. PP improves V/Q mismatch, reduces shunt and recruits posterior alveoli. APR is a PP strategy in awake/conscious patients, which improves oxygenation and dyspnea, and maybe prevents IV. APR can be autonomously achieved, which can be relevant during a pandemic context. CONCLUSIONS: APR leads to oxygenation and respiratory comfort improvement, possibly improving COVID19 prognosis and avoiding IV. Moreover, it may become a standard of care in ARF by other acute respiratory diseases. DISCLOSURE Nothing to declare. KEYWORD Awake proning