Prone positioning to improve oxygenation and relieve respiratory symptoms in awake, spontaneously breathing non-intubated patients with COVID-19 pneumonia

Abstract

Emergency departments are facing an unprecedented challenge in dealing with patients who have coronavirus disease 2019 (COVID-19). The massive number of cases evolving to respiratory failure are leading to a rapid depletion of medical resources such as respiratory support equipment, which is more critical in low- and middle-income countries. In this context, any therapeutic and oxygenation support strategy that conserves medical resources should be welcomed. Prone positioning is a well-known ventilatory support strategy to improve oxygenation levels. Self-proning can be used in the management of selected patients with COVID-19 pneumonia. Here, we describe our experience with two COVID-19-positive patients who were admitted with respiratory failure. The patients were successfully managed with self-proning and noninvasive oxygenation without the need for intubation.

Keywords: Acute respiratory distress syndrome; COVID-19; Coronavirus; Noninvasive ventilation; Prone positioning; Pulmonary ventilation.

© 2020 Published by Elsevier Ltd.

Figures

Fig. 1

Computed tomography scan showing pulmonary opacities with peripheral, multifocal ground-glass attenuation in both lungs, involving 25–50% of the pulmonary parenchyma, accompanied by consolidation in both lower lobes.

Fig. 2

Computed tomography scan showing pulmonary opacities with peripheral, multifocal ground-glass attenuation, together with small areas of consolidation involving approximately 50% of the pulmonary parenchyma, in both lungs.