Comparing the effect of strict versus routine awake prone positioning among patients hospitalized with COVID-19

ABSTRACT

Background: In patients with moderate to severe coronavirus disease 2019 (COVID-19), awake prone positioning improves oxygenation and clinical outcome. Despite prone positioning incorporated in the protocol, it's not followed in true letter and spirit. Aims and objectives: The objective of this study was to compare the effect of strict versus routine awake proning among patients hospitalized with Covid-19. Method(s) PCR positive COVID-19 patients admitted to the Khyber Teaching Hospital Peshawar's isolation unit were randomly allocated to 2 groups, Group A prone positioning (PP) was ensured for at least 12 hours by helping proning during rounds by the respiratory therapists and nurses. Further, prone positioning was ensured by the use of telemedicine, whereas Group B just followed the standard care in which awake proning was emphasized on a routine basis without doing any intervention. Their biochemical and clinical parameters, outcomes related to oxygen requirement, intubation, and mortality were followed weekly for two weeks or till discharge. Result(s) Out of the 58 patients, 29 patients with PP had a better outcome in terms of oxygenation (p<0.01), respiratory rate (P<0.05), and inflammatory markers such as serum ferritin (p<0.02) and C reactive protein (p<0.03). Additionally, ventilatory support (18% VS 42%, p<0.05) and mortality rate 21.4% Vs 64.3%) were significantly lower in the PP group. Conclusion(s) Strict compliance of awake prone positioning improved oxygenation in COVID-19 patients, resulting in a clinically better outcome.