“Conscious proning: An introduction of a proning protocol for non‐intubated, awake, hypoxic Emergency Department COVID‐19 patients”

Jiang, Lynn G.; LeBaron, Johnathon; Bodnar, David; Caputo, Nicholas D.; Chang, Bernard P.; Chiricolo, Gerardo; Flores, Stefan; Kenny, James; Melville, Laura; Sayan, Osman R.; Sharma, Manish; Shemesh, Amos; Suh, Edward; Farmer, Brenna

The novel coronavirus, or COVID‐19, has rapidly become a global pandemic. A major cause of morbidity and mortality due to COVID‐19 has been the worsening hypoxia which, if untreated, can progress to acute respiratory distress syndrome (ARDS) and respiratory failure. Past work has found that intubated patients with ARDS experience physiological benefits to the prone position, as it promotes better matching of pulmonary perfusion to ventilation, improved secretion clearance, and recruitment of dependent areas of the lungs. We created a system‐wide multi‐institutional (New York‐Presbyterian Hospital enterprise) protocol for placing awake, non‐intubated, Emergency Department patients with suspected or confirmed COVID‐19 in the prone position. In this piece, we describe the background literature and the approach we have taken at our institution as we care for a high burden of COVID‐19 cases with respiratory symptoms.