Proning Covid-19 patients who are awake and non-ventilated has benefits, according to research carried out at Addenbrooke’s Hospital.
It causes a small but significant benefit in oxygenation, with the effects being seen in less than ten minutes.
Proning is the placement of patients on to their stomachs and is used in the treatment of those in intensive care with acute respiratory distress syndrome - a life-threatening lung injury that allows fluid to leak into the lungs
The findings are significant because evidence to support proning of awake patients infected with SARS-CoV-2 is largely anecdotal – but they make up the majority of patients hospitalised with the condition.
The research was led by a coalition of willing medical students, junior doctors and senior clinicians drawn from different departments across the hospital and the University of Cambridge.
It was funded by Addenbrooke’s Charitable Trust (ACT) and lends weight to guidance from the Intensive Care Society - dedicated to the delivery of the highest quality of critical care - for a 15 minute trial to assess patient response.
It was carried out over six months with dozens of carefully selected patients and additionally explored the level of discomfort proning causes patients, and how long it can be tolerated.
Identifying suitable patients for proning was tricky. Significant numbers screened had co-morbidities such as dementia and obesity that had to be considered. Several were too anxious and too tired to try it.
The team noted different experiences, with some patients saying the prone position was the way they normally sleep, but with others finding it “hot, stuffy and uncomfortable.”
Dr Akhilesh Jha, of the hospital’s Department of Respiratory Medicine and university’s Department of Medicine, said:
“We know prone positioning works well to improve oxygenation in severe COVID-19 patients who are on a ventilator. However what was less clear is how effective it is on awake, unventilated patients with a milder, yet still serious, condition."
This study shows that awake proning causes a small but significant benefit in oxygenation and effects are seen within 10 minutes. However, choosing the most appropriate patients is key, together with being proactive with pillow support to help improve tolerability.
Dr Akhilesh Jha
Dr Jonathan Fuld, who is CUH clinical director for allergy, immunology, infectious diseases and respiratory teams added:
We would like to thank the inpatients at Addenbrooke’s hospital for participating in the study as well as the several medical students and junior doctors who contributed their time way beyond their normal clinical duties to help make the design and delivery of the study a success.
Dr Jonathan Fuld
ACT CEO, Shelly Thake, said:
ACT is delighted to be able to fund and invest in early stage research that goes on to have wider impact. This is one of the many projects funded, thanks to our generous donors, as part of the £1.175million that the charity made available towards Covid-19 research.
Shelly Thake
The research has just been published in the European Respiratory Society online research journal, ERJ Open Research (opens in a new tab). Read how Addenbrooke’s Charitable Trust (opens in a new tab) is changing thousands of lives.