Early Awake Prone and Lateral Position in Non-intubated Severe and Critical Patients with COVID-19 in Wuhan: A Respective Cohort Study

  1. Wei Dong
  2. Yiping Gong
  3. Juan Feng
  4. Lang Bai
  5. Haomiao Qing
  6. Peng Zhou
  7. Yu Du
  8. Junchen Zhu
  9. Shanling Xu

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Abstract

Background Previous studies suggest applying prone position (PP) and lateral position (LP) in patients with severe acute respiratory distress syndrome (ARDS) for their efficacy in improving oxygenation and lung recruitment.This paper aims to share clinical experiences and outcome of using PP and LP in combination with oxygen therapy (OT) and Non-invasive ventilation (NIV) in severe and critical patients with COVID-19. Methods Clinical data of 48 severe and critical patients have been retrieved from medical records and reviewed. The primary outcome is the survival rate. Secondary outcome is the rate of patients requiring intubation. Results In total, 25 patients were finally included in the study.The mean respiratory rate of all 25 patients decreased from 28.4 breaths/min to 21.3 breaths/min. CT results showed increase in lung recruitment. All patients tolerated PP and LP well. No deterioration or severe adverse events associated with PP and LP occurred. All patients recovered and survived without intubation. Follow-up to date showed that all patients have been discharged except one with mild symptoms and positive RNA test. Conclusion: Clinical outcomes of early application of PP and LP in combination with OT and NIV in severe and critical patients with COVID-19 indicated well tolerance of the therapy and resulted in improving patients' oxygenation in a safe and effective manner. Therefore, this strategy can be explored as an early intervention in managing patients in early stage of disease development under the context of pandemic and limited medical resources.

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  1. ScreenIT

    SciScore for 10.1101/2020.05.09.20091454: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analyses were conducted using SAS statistical software (version 9.3).
    SAS
    suggested: (SASqPCR, RRID:SCR_003056)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    As this observational study was done during the outbreak, it has some limitations. First, there were limited medical resources which impacted the oxygen support provided to patients. It should also be noted that the study was conducted in China, and thereby the environment and resources might be different from other countries. Second, the sample size is small considering the nature of an observational study. Although we noticed that a single case report30 and a pilot study31 have reported on similar strategy used in this study, our study reported on the clinical data of severe and critical patients during a long period of treatment and follow-up. Thirdly, some specific data about tests were missing. However, the limited findings still indicated positive effects of using PP and LP in managing patients with COVID-19. It would require large scale prospective clinical trials to explore the generalizability of these interventions among other COVID-19 patients in other countries and/or environments. In conclusion, using prone position and lateral position among patients at the early stage of the disease required less medical resources, and the outcome of this study suggested that the risks of generating new lesions and/or complications were low. Therefore, it might be beneficial to consider this as an early intervention, especially under the context of pandemic and limited medical resources.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.09.20091454v1 on medRxiv