Lorenzo Porta^1,2*, Giulio Cassano^1,2, Silvia Gheda^1,2, Adriano Basile¹ and Andrea Bellone¹

¹Emergency Medicine Department, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
²University of Milan-Bicocca, School of Medicine and Surgery, Monza, Italy

*Corresponding Author: Lorenzo Porta, Emergency Medicine Department, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy.

Received: October 05, 2021; Published: November 17, 2021

Abstract

Background: There is still paucity of data regarding pronation on non-intubated patients with respiratory failure due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2).

Objective: To evaluate the effects of prone and lateral positioning on acute respiratory failure (ARF) due to SARS-CoV-2 interstitial pneumonia.

Methods: We retrospectively analyzed data of all patients admitted to our medical ward from the 1^st of March to the 15^th of April 2020 with acute respiratory failure due to SARS-CoV-2 pneumonia. We compared patients mobilized in either lateral or prone positions with those mobilized just in sitting position. We recorded data on postural changes and all possible confounding variables. We assessed the relationship between postural changes and necessity of endotracheal intubation (ETI), obtaining crude and adjusted Odds Ratios (ORs), using conditional logistic regression analysis. Furthermore, we analyzed mortality for DNI (do not intubate) and actual intubation for non DNI, respectively.

Results: Our population of 98 patients had a male/female ratio of 3.25, a mean age of 65,6 years, a mean P/F of 183,3 and a median APACHE II score of 9. Crude and adjusted ORs with Confidence Interval (CI) for the need of ETI were 0,239 (CI95, 0,102-0,556, p 0,001) and 0,045 (CI95, 0,008-0,244, p < 0,001). Crude and adjusted ORs for ETI in the non-DNI population were 0,137 (CI95, 0,044-0,422, p 0,001) and 0,076 (CI95, 0,014-0,404, p 0,002), respectively. The OR for mortality in the DNI subgroup did not achieve statistical significance, even after adjustment. Compared to the sitting position, prone and lateral positions were associated with higher improvement in mean SpO₂ (+5.25% and +4.50%, respectively), with a partial benefit persistent after resupination (+3.68% and +1.87%, respectively).

Conclusions: Our study claims that the systematical application of prone and/or lateral positions can reduce ETI in SARS-CoV-2 patients with mild to severe ARF, due to a beneficial effect on SpO₂ and, thus, tissue hypoxia.

Keywords: Prone Positioning; SARS-CoV-2; Interstitial Pneumonia; Prone Ventilation; Acute Respiratory Failure; Non-intubated Patients

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Citation

Citation: Lorenzo Porta., et al. “Effect of Pronation and Postural Changes on Non-intubated Patients with Respiratory Failure Due to Covid-19 Interstitial Pneumonia”.Acta Scientific Medical Sciences 5.12 (2021): 94-103.

Copyright

Copyright: © 2021 Lorenzo Porta., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.