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.