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Evaluation of the outcomes of adjunctive awake-proning as a novel approach to the management of COVID-19 pneumonitis in a level 1 hospital ward setting

Joyeeta Palit, Alexandra Clay, Anne Tunbridge, Carol Keen

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In response to pressure on United Kingdom healthcare services due to the COVID-19 pandemic, a decision was made to pre-emptively awake-prone hypoxic patients with COVID-19 pneumonitis in a non intensive care unit (ICU) setting, with the aim of improving oxygenation and patient outcomes. This approach was trialled over 30 days from 30th March 2020, awake-proning patients for up to 15 hours a day in the first 72 hours of commencement. This case series was retrospectively analysed to characterise patients who tolerated the intensive regime (group A) versus those who ceased awake-proning early (group B). Additionally, length of stay in days was evaluated in the two groups. In total, 36 patients were proned – with an average of 2% point increase in oxygen saturations. Of these, 21 patients tolerated the intensive regime (average 1878 minutes/72 hours). Of the 15 people who ceased early (971 minutes/72 hours), only 4 were due to intolerable side effects. There were no major significant differences in baseline clinical characteristics between the two groups. Length of stay was significantly reduced in group A over group B even when adjusted for confounding of ICU stay (7.2 compared to 15.2 days p = 0.049). In conclusion awake-proning was successfully delivered in a level 1 setting, requiring the addition of 2 extra physiotherapy staff only. Further exploration is needed to explore the association of intensive regimes with reduced length of stay.

2021 Journal (Vol. 53 Issue 2)
Journal of the Association of Chartered Physiotherapists in Respiratory Care. Volume 53. Issue 2. 2021 Article on: p21-33
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