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Nursing & Health Sciences Research Journal

Abstract

Background: Prone positioning has been shown to improve clinical outcomes for sedated, mechanically ventilated individuals with moderate to severe respiratory illnesses. Some studies also show potential benefit to awake individuals with COVID-19.

Objectives: The primary aim of this study was to investigate if hospitalized non-critically ill individuals diagnosed with SARS-CoV-2 who engage in frequent proning are more likely to have improved outcomes compared to non-proning individuals.

Methods: A retrospective cohort design was used to assess outcomes associated with awake prone positioning. A convenience sample was used to select two cohorts of individuals admitted with COVID-19 from April 2020-March 2021. Cohort 1 included 89 individuals who did not engage in awake prone positioning (APP) for at least 3 hours per day, while Cohort 2 included 89 individuals who engaged in APP for at least 3 hours per day. Chart abstraction was used to collect patient demographics, clinical data, and subjective and objective observations related to pronation.

Results: Non-APP individuals were older (mean age 66.9 vs. 57.5; p = .001) and diagnosed with COVID-19 earlier (-0.27 vs. 2.07; p = .004) compared to APP individuals. APP individuals transferred to the ICU (27% vs. 13.5%; p = .03) and required endotracheal intubation (16.9% vs. 6.7%; p = .04) at a higher prevalence than non- APP individuals.

Discussion: APP was not associated with significantly fewer intubations and ICU transfers in this cohort of individuals with COVID-19. Stronger designs, such as randomized controlled trials, are needed to determine when APP is most beneficial in awake patients with COVID-19.

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