Awake prone positioning versus non invasive ventilation for COVID-19 patients with acute hypoxemic respiratory failure

Abstract

Background: Oxygenation failure one of the main covid-19 presentation in pandemic. Prone position (PP) and non-invasive ventilation (NIV) have been traditionally used in acute respiratory distress syndrome (ARDS) to improve oxygenation and avoiding invasive ventilation complications. Awake proning and noninvasive ventilation are being used as a therapy in COVID-19 hypoxic failure to improve outcomes. Methods: A prospective study of 30 COVID patients admitted in our Hospital critical care isolation. Co-operative hemodynamically stable patients, SaO2 ˂90%, PaO2/FiO2 ˂200, respiratory rate ˃ 24, bilateral lung infiltration on CT chest into two groups (15 pts in each) Oxygen was administered through non-rebreathing mask(NRB) mask O210-15 L/min with awake PP or NIV for 1-2 h each session, 3 h apart during waking hours for the first 3 days. Primary target improve oxygenation (SaO2 > 95% and P/f > 200 mm Hg), avoid intubation. ICU days and hospital stay are the secondary end points. Other COVID therapies were used according to our hospital protocol. Results: The mean SaO2 at admission 79 ± 8.47% in PP, 82 ± 7.05% in NIV, after PP or NIV applying the mean saO2 and paO2 was significantly increased (mean SaO2 93 ± 5.9%, mean PaO2 107 ± 12 mmHg)PP, (mean sop2 95 ± 4.2%, mean PaO2 129 ± 11 mmHg) NIV, the mean pacO2 was decreased significantly in NIV (39.34 ± 5.12 mmHg) compare to PP (43.41 ± 3.2 mmHg) p value ˂0.001 with no significant results regarding the PH (7.40 ± 0.02&7PP group.33 ± 0.06 NIV group), ICU mortality 20% in each group in whom need intubation, with no significant value in ICU or hospital stay. Conclusion: Awake prone positioning and non-invasive ventilation showed marked improvement in SaO2 and PaO2 in COVID-19 patients with improvement in clinical symptoms with reduced rate of intubation with superiority of NIV in hypercapnic patients.