Introduction
Considering the current global pandemic and the consequential
devastating effects on the respiratory function of patients who test
positive for the coronavirus disease of 2019 (COVID-19), new ways are
being sought to improve health outcomes. Patients with COVID-19 often
present with severe hypoxemia and acute respiratory distress, leading to
supplemental oxygen therapy and intubation. Self-pronation is one
intervention that may improve low oxygen saturation levels (SpO2),
relieve shortness of breath (SOB), and potentially reduce intubation
rates in patients who develop respiratory symptoms of the virus.
Researchers reported that lying in the prone position improves lung
function in hospitalized patients with severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) (the virus that causes COVID-19) requiring
tracheal intubation and assisted
ventilation.[1][2][3] As patients practice
prone positioning, they mitigate abnormal lung tissue strain and
injuries related to mechanical ventilation and decrease their risk of
intubation.[2] Another study found that awake
early self‐proning in the emergency department (ED) resulted in improved
oxygenation and decreased respiratory effort in the COVID‐19 positive
patient.[4] These findings provide evidence-based
information beneficial in the clinical setting to improve health
outcomes and mortality for COVID-19 positive
patients.[5]
There is limited research in the area that directly addresses how a
patient’s self-prone positioning (i.e., stomach versus lateral recumbent
proning) affects their oxygenation and outcomes. To further explore this
concept, we conducted an observational study to determine the effects of
self-proning on the independent and awake COVID-19 positive patient with
oxygen deficits. Our aim was to explore the effects of self-proning
methodology on a large population of admitted COVID-19 patients on
oxygenation and evaluate their tolerance level for the intervention and
the potential to avoid intubation. We hypothesize that all self-proning
positioning (including stomach and lateral recumbent proning) improves
oxygen saturation, relieves respiratory distress, and may reduce the
incidence of intubation in COVID-19 positive patients.