Self-Proning in COVID-19

Westafer, Lauren M . NEJM Journal Watch. Emergency Medicine ; Waltham (May 1, 2020).

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ABSTRACT (ENGLISH)
In this observational study, oxygen saturations in patients with COVID-19 increased after self-proning for 5
minutes.

FULL TEXT
Patients with severe COVID-19 often present with profound hypoxemia. Initial recommendations for their
management included early intubation, but this was not predicated on evidence. Recently, many hospitals have
initiated awake or self-proning protocols early in patients' hospital courses, in an attempt to improve oxygenation
and stave off intubation. Unlike the labor-intensive and risky proning procedure in patients with acute respiratory
distress syndrome (in which patients are paralyzed, sedated, and rotated onto their stomachs), with self-proning,
alert patients roll onto their stomachs or sides by themselves.
In this observational study, researchers in a New York City emergency department measured the change in oxygen
saturation 5 minutes after self-proning in 50 patients with hypoxia and suspected (subsequently confirmed)
COVID-19. Median oxygen saturation was 80% on arrival and increased to 84% after patients were placed on
supplemental oxygen. After 5 minutes of proning, median oxygen saturation increased to 94%. Ultimately, 36% of
patients were intubated within 72 hours and, of these, 38% (7) were intubated within the first hour.
In this small study, self-proning improved patients' oxygenation at 5 minutes, but the duration of its effect is
unclear. Notably, intubation was avoided in nearly two thirds of patients, adding support to the shift toward
noninvasive modalities and self-proning in the initial management of patients with COVID-19 and significant
hypoxemia, without respiratory distress. However, some of these patients will still require intubation during their
hospital course, and so all of them should be monitored closely.
References
Caputo ND et al. Early self-proning in awake, non-intubated patients in the emergency department: A single ED's
experience during the COVID-19 pandemic. Acad Emerg Med 2020 Apr 22; [e-pub].
(https://doi.org/10.1111/acem.13994)

DETAILS

Subject: Intubation; Respiratory therapy; Coronaviruses; COVID-19

Publication title: NEJM Journal Watch. Emergency Medicine; Waltham

Publication year: 2020

Publication date: May 1, 2020

Publisher: Massachusetts Medical Society

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 Place of publication: Waltham

Country of publication: United States, Waltham

Publication subject: Medical Sciences--Orthopedics And Traumatology

ISSN: 23300531

Source type: Scholarly Journals

Language of publication: English

Document type: News

ProQuest document ID: 2397200961

Document URL: https://www.proquest.com/scholarly-journals/self-proning-covid-

19/docview/2397200961/se-2?accountid=208627

Copyright: Copyright © 2020 Massachusetts Medical Society. All rights reserved.

Last updated: 2021-01-12

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