The comparison of the effectiveness of prone lying, vs non-invasive ventilation in bringing about improved oxygenation in patients suffering from COVID-19 within an ICU setting

Abstract

Background: COVID-19 is an infectious disease that is caused by the SARS-CoV-2 virus of aerosol spread through air droplets (WHO 2021). WHO (2021) reported over 240 million COVID-19 cases, with over 4.9 worldwide deaths since December 2019. Prone positioning and NIV have been suggested as alternative treatments to mechanical ventilation, in the improvement of oxygenation, however this recommendation lacks evidence. In this study both modalities are compared, in patients diagnosed with COVID-19 in an ICU setting. Research question: Would prone lying, as compared to non-invasive ventilation result in the improvement of oxygenation in patients suffering from COVID-19, in an ICU setting? PICO elements: The population (P) selected was patients diagnosed with COVID-19 in ICU settings. Interventions (I) selected were prone positioning (pp) compared (C) with Non-invasive ventilation (NIV). The outcome (O) desired was improvement in oxygenation. Method: An extensive evidence-based search was performed using 5 different electronic databases. The inclusion criteria included articles having population of over 200 people and were written in English. Furthermore, Meta-Analysis (MA), systematic reviews (SRs), Randomized controlled trials (RCTs), Evidence-based guidelines and Cohort studies (CS) formed part of the inclusion criteria. Five articles were selected including 2 SR, 2 evidence-based guidelines and 1 CS. Finally, CASP tools including Boolean operators were used for critical appraisal of literature. Ethical issues were also considered. Results: Through appraisal of the literature, pp was found to be effective in the improvement of oxygenation. On the other hand, NIV was less effective in this improvement when compared to pp. However, several methodological limitations were found, indicating the need for more research in this sector. Implications and Recommendations: The importance of further evidence-based research was identified to perform proper standardization of selected interventions, both locally and internationally. The importance of standardization needs to be discussed with HCPs whilst specific training needs to be administered, aiming to provide effective treatment.