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Prone position protocol in awake COVID-19 patients: A prospective study in the emergency department.
Althunayyan, Saqer; Almutary, Abdulaziz M; Junaidallah, Mohammad Asim; Heji, Anas Saleh; Almazroua, Faisal; Alsofayan, Yousef M; Al-Wathinani, Ahmed; AlRuthia, Yazed.
  • Althunayyan S; Department of Accident and Trauma, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia. Electronic address: salthunayyan@ksu.edu.sa.
  • Almutary AM; Emergency Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia. Electronic address: dr.aziz1405@gmail.com.
  • Junaidallah MA; Emergency Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia. Electronic address: Maqs-j@hotmail.com.
  • Heji AS; Emergency Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia. Electronic address: aheji@moh.gov.sa.
  • Almazroua F; Emergency Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia. Electronic address: f.almazroua@ksmc.med.sa.
  • Alsofayan YM; Executive Directorate of Medical Affairs, Saudi Red Crescent Authority, Riyadh, Saudi Arabia. Electronic address: y-m-alsofayan@hotmail.com.
  • Al-Wathinani A; Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia. Electronic address: ahmalotaibi@ksu.edu.sa.
  • AlRuthia Y; Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia. Electronic address: yazeed@ksu.edu.sa.
J Infect Public Health ; 15(4): 480-485, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1709324
ABSTRACT

BACKGROUND:

Limited effective interventions exist in the emergency department (ED) for COVID-19 patients with respiratory failure. One of the promising interventions is the prone position, which has been proven to improve oxygenation in ICU settings. Here, we aimed to describe and assess the utility of the prone position in awake non-intubated adult patients in EDs during the COVID-19 pandemic.

METHODS:

We conducted a prospective cohort study of hypoxic COVID-19 adult patients who presented to our emergency department. We collected the data from June to the end of August 2020, including vital signs and physiological and clinical parameters before and after completing the four-hour prone position protocol. The main outcomes assessed were improvement in oxygenation, respiratory rate, respiratory distress score, ICU admission, and intubation. Oxygenation was calculated based on the standard pulse oximeter saturation [SpO2]/fractional concentration of oxygen in inspired air (FiO2).

RESULTS:

The study included 49 patients (81.63% men; mean age, 53.37 ± 11 years). The mean oxygen saturation during the triage was 84.49% ± 7.98 on room air. After completing of the four-hour prone protocol, the mean SpO2/FiO2 ratio increased from 1.62 ± 0.78-1.99 ± 0.75 (p < 0.0001). The respiratory rate decreased from 32.45 ± 5.24-26.29 ± 5.40 (p < 0.0001). Respiratory distress scores decreased after changing patients' positions (p < 0.0001). Twenty-four patients (48.9%) were admitted to the ICU, 6 patients were intubated (12.2%), and 7 (14.3%) died in the hospital.

CONCLUSION:

After applying the prone position in the ED, significant and immediate improvement was observed in oxygenation, respiratory rate, respiratory distress, and carbon dioxide levels. A linear relationship between the level of improvement in oxygenation and reduction in ICU admission was observed. However, further studies recommended to assess the advantage of the procedure in terms of ICU admission, intubation, or mortality.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: J Infect Public Health Journal subject: Communicable Diseases / Public Health Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: J Infect Public Health Journal subject: Communicable Diseases / Public Health Year: 2022 Document Type: Article