The efficacy of early prone or lateral positioning in severe COVID-19 patients: A single-center prospective cohort

Ni, Zhong; Wang, Kaige; Wang, Ting; Ni, Yuenan; Huang, Wei; Zhu, Ping; Fan, Tao; Wang, Ye; Wang, Bo; Deng, Jun; Qian, Zhicheng; Liu, Jiasheng; Cai, Wenhao; Xu, Shanling; Du, Yu; Wang, Gang; Liang, Zongan; Li, Weimin; Luo, Jianfei; Luo, Fengming; Liu, Dan

BACKGROUND: Position intervention has been shown to improve oxygenation, but its role in non-invasively ventilated severe COVID-19 patients has never been assessed. The objective of this study was to investigate the efficacy of early position intervention on non-invasively ventilated severe COVID-19 patients. METHODS: This was a single-center, prospective observational study in consecutive severe COVID-19 patients managed in a provisional ICU at Renmin Hospital of Wuhan University during January 31(st) to February 15(th), 2020. Patients with chest CT showing exudation or consolidation in bilateral peripheral and posterior part of the lungs were included. Early position intervention (prone or lateral) was commenced for > 4 hours daily for 10 days, while others had standard care. RESULTS: The baseline parameters were comparable between position intervention group (n = 17) and standard care group (n = 35). Position intervention was well-tolerated and increased cumulative adjusted mean difference of SpO(2)/FiO(2) (409, 95% CI 86 to 733) and ROX index (26, 95% CI 9 to 43) with decreased Borg scale (−9, 95 CI −15 to −3) during first 7 days. It also facilitated absorption of lung lesions and reduced patients of high National Early Warning Score 2 (≥ 7) on days 7 and 14 with a trend toward fastened clinical improvement. Virus shedding and length of hospital stay were comparable between the two groups. CONCLUSIONS: This study provides the first evidence for improved oxygenation and lung lesion absorption using early position intervention in non-invasively ventilated severe COVID-19 patients and warrants further randomized trials.