Prone Position for Nonintubated Patients With COVID-19 and Hypoxemic Respiratory Failure
Prone Position for Nonintubated Patients With COVID-19 and Hypoxemic Respiratory Failure
The aim of this observational study is to evaluate the physiological and clinical effects of
 prone position in awake patients with respiratory failure due to COVID-19.
The purpose of this study is to investigate the role of prone positioning in SARS-CoV-2
 infected patients that are not intubated. Prone patient placement during invasive mechanical
 ventilation is a widespread practice in the management of severe ARDS. However, few attempts
 have been made to implement the prone position in patients that spontaneously ventilate with
 supplemental oxygen. Considering that it is a procedure that does not require additional
 equipment and does not represent an additional cost for its implementation, it becomes a
 valuable tool in the context of COVID-19 where intubation is associated with high mortality.
 The investigators will analyze a cohort of patients with COVID-19 and respiratory failure
 managed with prone position as indicated by the attending physician and register
 physiological variables and clinical outcomes (intubation and death).
Inclusion Criteria:

 -  Hospitalized patients with confirmed or suspected COVID-19 pneumonia requiring more
 than 3 liters per minute of supplemental oxygen or a Fraction of Inspired Oxygen
 (FIO2) over 35% to keep Pulse Oximetry Saturation (SpO2) over 90%

 -  Treating physician indicated prone position as instructed by the institutional
 protocol

 -  Patient capable of changing position with minimal help from the personnel

 Exclusion Criteria:

 -  Patient requiring immediate intubation

 -  Patient requiring non-invasive mechanical ventilation

 -  Respiratory Rate > 40, signs of respiratory fatigue or unconsciousness with inability
 to protect the airway

 -  PaCO2 > 50mmHg

 -  Hemodynamic instability (defined by Heart Rate > 120, Systolic Pressure < 90mmHg, Mean
 Arterial Pressure < 60mmHg or requiring vasopressor support)

 -  Obesity with BMI > 40 (Body Mass Index: weight in kilograms and height in meters will
 be combined to attain BMI in kg/m2)

 -  Persistent vomiting

 -  Facial or thoracic trauma or recent surgery contraindicating the prone position

 -  Pregnancy > 20 weeks