Impact of proning in spontaneously breathing COVID-19 patients in an emergency department in Brazil
COVID-19, Emergency medical services, Prone position, Intubation, Mortality
Proning has been used during the pandemic in spontaneously breathing COVID-19 patients to improve oxygenation and reduce the risk of endotracheal intubation (ETI), having a positive impact on patient survival. Aims: To identify the proning success rate for preventing ETI and/or death in COVID-19 patients admitted to an emergency department (ED) and assess respiratory and cardiovascular responses associated with the technique. Methods: We conducted a retrospective cohort study using data from patient medical records. We assessed 43 patients divided into two groups: success group (maintenance of spontaneous breathing); and failure group (ETI and death). The following respiratory and cardiovascular variables were assessed: respiratory rate (RR), peripheral oxygen saturation (SpO2), peripheral oxygen saturation and inspired fraction of oxygen ratio (SpO2/FiO2), heart rate (HR), and mean arterial pressure (MAP). The data were analyzed using the Shapiro-Wilk and Student's t tests. Results: Of the 43 patients that underwent proning, 25 (58%) were not intubated and survived. The respiratory responses (RR, SpO2, and SpO2/FiO2) were significantly better in the success group than in the failure group (p ≤ 0.05). There were no statistically significant differences in cardiovascular variables between the two groups. Conclusion: Proning in spontaneously breathing COVID-19 patients led to a reduction in ETI and mortality rates and respiratory responses were significantly better in the success group.