Avoiding mechanical ventilation in COVID-19 patients : self proning versus supine position

Abstract

Topic: Corona Virus (Covid-19) caused an increase in ITU admissions during the Covid19 pandemic. The practice of prone positioning was considered for decades as help in improving oxygenation in patients suffering from respiratory distress. However, there is no evidence if this practice helps in avoiding mechanical ventilation in Covid 19 patients with respiratory problems. The aim of this dissertation was to determine whether awake prone position (APP) helps to accomplish the latter. PICO Question: In Self-Ventilating patients who contracted covid 19 virus, does self proning compared to supine position, decrease the likelihood of endotracheal intubation & mechanical ventilation? Research Methods: HyDi, PubMed, Google Scholar and EBSCO host were used for literature search. Two Randomized control trials (RCT), and two systematic reviews (SR) were finally chosen for critical appraisal (CA) after a thorough full text analyses of 16 studies which were considered relevant to the research question. The Critical Appraisal Skill Programme (CASP) was used for CA. Results: Two SRs and one RCT concluded that APP helps in blood oxygenation. Moreover, one of the SRs reported also a reduction in mechanical intubation. The other RCT reported no difference when APP is compared to supine position. Conclusion: There is no clear evidence which indicates that APP reduces the risk of mechanical ventilation in covid 19 positive patients. However, Covid 19 is a recent disease compared to other communicable and non-communicable diseases; and as highlighted by the authors of the retrieved studies, more evidence-based research and studies are recommended. Recommendations: As already indicated, more future research is recommended. It is recommended also that health care professionals are updated with the latest evidence based practices on the care of ventilated patients. A clinical care protocol regarding proning is suggested by the author.