Impact of Prone Positioning in Covid Patients Improves Oxygenation and Decreases Mortality
| Article 4 | Prone Positioning of Non-intubated Patients with COVID-19
(Damarla et al., 2020) |
| Quantitative/ Qualitative? Why? | Quantitative because it uses statistical analysis |
| Purpose Statement | “The study aimed to determine the benefits that patients with COVID-19 and respiratory distress, not yet intubated but at high risk for intubation, might achieve from prone positioning.” |
| Research Question | Not given |
| Outcome | “Primary outcome: change in oxygen saturation and respiratory rate before proning and approximately 1 hour after initial proning compared with pre-proning.
Secondary outcome: incidence of intubation within 2 weeks of the first prone-positioning trial.” |
| Setting | Academic medical center |
| Sample | 10 patients |
| Method | Retrospective review |
| Key Finding | All patients experienced significant improvement in respiratory status during the initial prone-positioning period |
| Recommendations for Researchers | Future research avenues include: “How long does the effect of proning last? Does the beneficial effect of proning continue after supination? Does proning prevent the need for intubation or merely delay it? Could prone positioning accelerate recovery?” |
| Article 5 | Effect of awake prone positioning in COVID-19 patients- A systematic review
(Anand et al., 2021) |
| Quantitative/ Qualitative? Why? | Mixed methods because it employs systematic review of the literature and statistical analysis |
| Purpose Statement | “We aim to conduct a systematic review of the available literature to highlight the effect of awake proning on the need for intubation, improvement in oxygenation, and mortality rates in COVID-19 patients with ARDS.” |
| Research Question | Not given |
| Outcome | “The proportion of patients requiring intubation, improvement in oxygenation, and mortality rates.” |
| Setting | Not given |
| Sample | 2 medical databases (PubMed, Google Scholar)
13 studies with 210 patients |
| Method | Systematic Review of Literature |
| Key Finding | “Awake-prone positioning demonstrated an improvement in oxygenation of the patients suffering from COVID-19 related respiratory disease.” |
| Recommendations for Researchers | “Early and frequent proning in patients suffering from COVID-19 associated ARDS, however, randomized controlled trials are needed before any definite conclusions are drawn” |
| Article 6 | Prone Position to Improve Oxygenation in COVID-19 Patients Outside Critical Care (PRONE-COVID)
(Fuld, 2020) |
| Quantitative/ Qualitative? Why? | Mixed-Method |
| Purpose Statement | “The study aims to improve understanding of physiological effects of prone positioning in non-ventilated patients with COVID-19 and a control group of patients with non-COVID-19 related pneumonia. The study also aims to incorporate a small subset of patients, with an approximately even spread of COVID-19 and non-COVID cases, which allows for an additional exploratory descriptive report on prone positioning over 24 hours.” |
| Research Question | Not given |
| Outcome | Effects of prone versus supine or lateral position on respiratory rate, heart rate, blood pressure |
| Setting | Cambridge University Hospitals NHS Foundation Trust |
| Sample | 56 participants |
| Method | Interventional Case Study |
| Key Finding | “Prone positioning improves oxygenation in non-ventilated patients with pneumonia (COVID-19 related or not) requiring supplemental oxygen managed outside of the critical care setting.” |
| Recommendations for Researchers | “The Intensive Care Society in non-ventilated patients with COVID-19, there is an urgent need to better understand the physiological effects of prone positioning in such cases.” |
References
Anand, S., Baishya, M., Singh, A., & Khanna, P. (2021). Effect of awake prone positioning in COVID-19 patients- A systematic review. Trends in Anaesthesia and Critical Care, 36, 17–22. https://doi.org/10.1016/j.tacc.2020.09.008
Behesht Aeen, F., Pakzad, R., Goudarzi Rad, M., Abdi, F., Zaheri, F., & Mirzadeh, N. (2021). Effect of prone position on respiratory parameters, intubation and death rate in COVID-19 patients: Systematic review and meta-analysis. Scientific Reports, 11(1), 14407. https://doi.org/10.1038/s41598-021-93739-y
Clarke, J., Geoghegan, P., McEvoy, N., Boylan, M., Ní Choileáin, O., Mulligan, M., Hogan, G., Keogh, A., McElvaney, O. J., McElvaney, O. F., Bourke, J., McNicholas, B., Laffey, J. G., McElvaney, N. G., & Curley, G. F. (2021). Prone positioning improves oxygenation and lung recruitment in patients with SARS-CoV-2 acute respiratory distress syndrome; a single-center cohort study of 20 consecutive patients. BMC Research Notes, 14(1), 20. https://doi.org/10.1186/s13104-020-05426-2
Damarla, M., Zaeh, S., Niedermeyer, S., Merck, S., Niranjan-Azadi, A., Broderick, B., & Punjabi, N. (2020). Prone Positioning of Nonintubated Patients with COVID-19. American Journal of Respiratory and Critical Care Medicine, 202(4), 604–606. https://doi.org/10.1164/rccm.202004-1331LE
Fuld, D. J. (2020). Prone Position to Improve Oxygenation in COVID-19 Patients Outside Critical Care (PRONE-COVID Study) (Clinical Trial Registration No. NCT04589936). clinicaltrials.gov. https://clinicaltrials.gov/ct2/show/NCT04589936
Perez-Nieto, O. R., Escarraman-Martinez, D., Guerrero-Gutierrez, M. A., Zamarron-Lopez, E. I., Mancilla-Galindo, J., Kammar-García, A., Martinez-Camacho, M. A., Deloya-Tomás, E., Sanchez-Diaz, J. S., Macías-García, L. A., Soriano-Orozco, R., Cruz-Sánchez, G., Salmeron-Gonzalez, J. D., Toledo-Rivera, M. A., Mata-Maqueda, I., Morgado-Villaseñor, L. A., Martinez-Mazariegos, J. J., Ramirez, R. F., Medina-Estrada, J. L., & Ñamendys-Silva, S. A. (2021). Awake prone positioning and oxygen therapy in patients with COVID-19: The APRONOX study. European Respiratory Journal. https://doi.org/10.1183/13993003.00265-2021
