Prone Positioning of Patients With Coronavirus Disease 2019 Who Are Nonintubated in Hypoxic Respiratory Distress: Single-Site Retrospective Health Records Review.
Christine Wendt, Kristi Mobus, Dan Weiner and 2 others
PMID 33558073WHAT IT FOUND
Nurse-initiated prone positioning in awake, alert nonintubated ED patients with COVID-19 raised median SpO2 by 5%, from 90% to 96%.
No control group, so benefit is not proven.
Key findings
01The primary outcome, SpO2, improved by a median 5% (IQR 4%-9%) after prone positioning, from 90% (IQR 89%-93%) before to 96% (IQR 94%-98%).
02Heart rate and respiratory rate both decreased slightly after prone positioning: mean HR 93 (SD 18) to 88 (SD 15) beats/min and respiratory rate 31 (SD 9) to 26 (SD 8) breaths/min.
03In the 24 patients whose supplemental oxygen was not increased when proned, median SpO2 rose 4% (IQR 3%-6%), from 92% (IQR 89%-93%) before to 96% (IQR 94%-98%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single-site retrospective chart review with no control group, so the SpO2 rise cannot be separated from time, oxygen changes, movement, ambient temperature or other ED care. Small sample of 31 included patients, with missing data, especially duration of prone positioning. Only patients who tolerated proning and met oxygen thresholds were included, so results may not apply to patients who could not lie prone or had different oxygen levels. Supplemental oxygen was increased for 7 patients when proned; although the 24 patients with no oxygen increase also improved, the intervention was not isolated. The main outcome was short-term SpO2, not intubation, mortality or sustained oxygenation after returning supine. Demographics may limit generalizability: mean age 62 years, 13% female, 55% Hispanic.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not conclude that prone positioning prevents intubation or death; this before-after chart review showed only short-term SpO2 improvement and had no control group.