Self Prone Therapy for Non-Ventilator COVID-19+ Patients
Topic of Interest
Role of CNS in COVID-19 Pandemic
Abstract
Significance and Background:
Patients with novel coronavirus pneumonia (NCP) can present with hypoxemia and acute respiratory distress syndrome (ARDS). Proning is an evidence-based intervention recommended for intubated patients with severe ARDS. Proning improves ventilation-perfusion matching in the lung and increases the number of alveoli available to participate in gas exchange. Anecdotal evidence suggests that non-intubated self-proning has a positive effect on intubation and therefore intensive care unit utilization. A proactive self-proning protocol was targeted for positive NCP patients within the acute-care setting.
Evaluation and Methods:
A multidisciplinary approach was utilized to develop the protocol for clinicians to implement on patients who were positive or suspected for NCP. Evidence based inclusion and exclusion criteria were included in the protocol. Vital signs and the patient's response to self-proning were collected at predetermined intervals before, during and after proning therapy. Additionally, at the completion of therapy the length of time in the prone position as well as new adverse symptoms were documented.
Outcomes:
Desired outcomes included improvement in oxygen saturation, reduced supplemental oxygen needs, and avoidance of intubation. Preliminary data has shown positive outcomes with all but two patients avoiding intubation. Adverse outcomes include new onset of headache, decreased blood pressure, inability to tolerate the prone position, or the need for intubation with ICU transfer.
Implications:
Collecting and quantifying data from the electronic medical record to validate outcomes has been a challenge. Interdisciplinary collaboration between beside nurses, Clinical Nurse Specialists, Respiratory Therapists, Physical Therapist, and Medical Providers can greatly impact the continued efforts and success of this therapy. Patients meeting contraindications to proning were encouraged to assume lateral positioning while lying in bed, data was not collected around outcomes for these patients.