Authors: Xu Q, Wang T, Quin X, Zha L
PMID: 32448330 PMCID: PMC7246000 DOI: 10.1186/s13054-020-02991-7
Abstract
Coronavirus disease 2019 (COVID-19) has rapidly spread around the world in the past 3 months and has now become a global public health crisis. The mortality of COVID-19 in some European cities exceeds 11%, and the fatality rate is up to 61.5% in critical patients, especially in mechanically ventilated patients. Once mild to moderate patients progress to critical illness, the incidence of septic shock, intubation, and myocardial injury increases significantly. Mechanical ventilation patients need more sedative, analgesic, and neuromuscular blocker drugs, which will affect the patient’s hemodynamic status and airway expectoration ability. Previous studies have confirmed that high-flow nasal cannula (HFNC) can reduce the endotracheal intubation rate and mortality in patients with respiratory failure. However, this therapy of COVID-19 cannot improve the pathophysiology of ventilation-perfusion defects and atelectasis, which can be proved by autopsies, i.e., small airways are blocked by mucus plugs. Awake prone position could improve the mismatch of ventilation-perfusion and open the atelectatic lungs by adequate sputum drainage. So far, the role of early awake prone position (PP) combined with HFNC therapy in the treatment of severe COVID-19 has not been reported. So, we conducted a retrospective observation study in three hospitals in Wuhu and Maanshan cities in Anhui Province.
From January 1 to April 2, 2020, 79 patients with coronavirus infection were screened. Ten was severe and all of them received early awake PP combined with HFNC treatment (Table 1). COVID-19 was diagnosed using sputum or throat swab determined by real-time reverse transcription polymerase chain reaction (RT-PCR) assay. The severity of disease was graded according to the Guidelines for the Diagnosis and Treatment of Novel Coronavirus (2019-nCoV) Infection by the National Health Commission. The target time of prone positioning is more than 16 h per day and can be appropriately shortened according to the patient’s tolerance. Target SpO2 was more than 90% of adult non-pregnant patients.
Keywords: COVID-19; High-flow nasal cannula; Prone positioning; SARS-CoV-2.
