Awake Prone Positioning and Oxygen Therapy in Patients With COVID-19

Study Overview
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Brief Summary
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The prone position strategy for patients with acute respiratory distress syndrome (ARDS) is simple and cost-effective from the first description on its use in patients with acute respiratory failure to improve hypoxemia. Different studies have investigated its safety and efficacy in various clinical settings, demonstrating that its early use in combination with non-invasive mechanical ventilation (NIV) or high-flow oxygen therapy can reduce intubation rate and mortality in ARDS. In the Coronavirus disease 2019 (COVID-19) pandemic, high-value medicine and resource optimization are critical.

Detailed Description
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Coronavirus disease 2019 (COVID-19) is a pandemic that has significantly challenged health systems worldwide. Due to the large number of infections around the world, the implementation of strategies to reduce the number of intubations and the need for invasive mechanical ventilation becomes important. In addition to the inability of the Mexican health system to respond, patients under invasive ventilation have not had a favorable survival outcome. Up to 97% mortality has been reported in patients requiring intubation. The exact cause of this poor prognosis is not yet known. Early recognition of hypoxemic patients could help with the results. It seems reasonable in these patients to perform procedures to improve the clinical respiratory picture before intubation in less severe cases due to the aforementioned. Prone patient placement during invasive mechanical ventilation is a widespread practice in the management of severe ARDS of other etiologies. Currently, few attempts have been made to implement the prone position in patients who spontaneously ventilate with supplemental oxygen, high-flow nasal cannulas, or noninvasive mechanical ventilation. Taking into account that it is a procedure that does not require additional infrastructure within the services and does not represent an additional cost for its implementation, it becomes a valuable tool in the context of COVID-19 where intubation is associated with high mortality and in a Additionally, there are mechanical ventilator deficits in most hospitals. This work has feasibility to be carried out because it will be carried out in critical areas that have equipment and trained personnel for it in the different shifts, in addition to having patients diagnosed with COVID-19.

Official Title
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Awake Prone Positioning and Oxygen Therapy in Patients With COVID-19 (APRONOX)

Conditions
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COVID, ARDS, Pneumonia

Intervention / Treatment
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* Procedure: Prone position


Participation Criteria
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Eligibility Criteria
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Inclusion criteria Patient records with the following characteristics: Patients over 18 years of age Patients of both genders Patients diagnosed with COVID-19 infection Patients admitted to hospital Complete file Non-inclusion criteria • Patients who do not decide to participate in the study Exclusion criteria • Files not found. Elimination criteria Files with incomplete data File with a voluntary discharge or transfer note.

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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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| COVID<br>Patients with or without prone position | Procedure: Prone position<br>* Position of the patient in which he is face down, for an improvement in oxygenation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To analyze the relationship between the prone position and the need for orotracheal intubation. | Relationship between awake prone position and the tracheal intubation | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The impact of the prone position on the partial oxygen saturation / inspired oxygen fraction index (SaO2 / FiO2). | See the relationship between the awake prone position and the SaO2/FiO2 INDEX | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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COVID, ARDS, PRONE POSITION