Awake Proning in COVID-19 Patients With Hypoxemic Respiratory Failure

Study Overview
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Brief Summary
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The purpose of this study is to retrospectively review clinical data to determine whether awake proning improves oxygenation in spontaneously breathing patients with COVID-19 severe hypoxemic respiratory failure.

Detailed Description
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Critically ill patients with coronavirus disease 2019 (COVID-19) severely strained intensive care resources in New York in April 2020. The prone position improves oxygenation in intubated patients with acute respiratory distress syndrome. The investigators wanted to study whether the prone position is associated with improved oxygenation and decreased risk for intubation in spontaneously breathing patients with severe COVID-19 hypoxemic respiratory failure. Awake prone positioning was implemented based on the health care provider decision.

Official Title
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Awake Proning in Patients With COVID-19-Induced Acute Hypoxemic Respiratory Failure

Conditions
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Oxygen Deficiency, Coronavirus Infection

Intervention / Treatment
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* Other: Awake proning


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Consecutive patients admitted to the Columbia University step-down unit from April 6, 2020. Laboratory confirmed COVID-19 infection with severe hypoxemic respiratory failure defined as respiratory rate ≥30 breaths/min and oxyhemoglobin saturation (SpO2) ≤93% while receiving supplemental oxygen 6 L/min via nasal cannula and 15 L/min via non-rebreather facemask. Exclusion Criteria: Altered mental status with inability to turn in bed without assistance Extreme respiratory distress requiring immediate intubation, or oxygen requirements less than specified in the inclusion criteria.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Awake Proning<br>COVID-19 patients with hypoxemic respiratory failure with awake prone positioning, as tolerated, up to 24 hours daily. | Other: Awake proning<br>* Prone positioning of awake, as tolerated, for up to 24 hours daily.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in SpO2 | SpO2 was measured by peripheral pulse oximetry. | Before proning and 1 hour after initiation of the prone position | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Risk Difference in Intubation Rates | The mean risk difference in intubation rates for patients with SpO2 ≥95% vs. <95% 1 hour after initiation of the prone position was assessed. | Duration of hospitalization or up to 1 month from admission | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Awake Proning, COVID-19, SARS-CoV-2