Effect of Pronation and Postural Changes on Non-intubated Patients with Respiratory Failure Due to Covid-19 Interstitial Pneumonia
Lorenzo Porta1,2*, Giulio Cassano1,2, Silvia Gheda1,2, 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.
October 05, 2021; Published: November 17, 2021
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 1st of March to the 15th 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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