Lying down may not be beneficial for all patients with COVID-19 with hypoxemia

According to the COVI-PRONE study, the supine position did not significantly reduce the risk of intubation in hospitalized patients experiencing acute hypoxemic respiratory failure from COVID-19. However, patients who receive high-flow oxygen may benefit from the waking position. This international multicenter randomized clinical trial also found that the supine position did not have a significant effect on death and length of stay in the intensive care unit or in the hospital.

The supine (or supine) position is a procedure in which patients lie face down for a prescribed time. It has been used since the 1970s in patients undergoing mechanical ventilation for acute respiratory distress syndrome. The waking state is prone to this procedure, which is performed by conscious patients who are not exposed to mechanical ventilation.

Outside of Canada, slope location is widely used and widely used throughout the pandemic, despite the lack of evidence to support its safety or effectiveness.

At the beginning of the COVID-19 pandemic, it was thought that the location on the slope was a potentially useful intervention that required further investigation. Although some studies have shown that placement is safe, there was insufficient evidence to recommend the use of this strategy in clinical guidelines.

“We developed COVI-PRONE to provide solid evidence because our prior knowledge was based on poor-quality data from observational studies,” said lead researcher Walid Alhazani, McMaster University professor of medicine and St. Joseph’s resuscitation physician at Hamilton Health. .

The COVI-PRONE trial included 21 hospitals in Canada, Saudi Arabia, Kuwait and the United States. The researchers aimed to use the supine position in patients with COVID-19 hypoxemia for 8-10 hours a day with 2-3 breaks as needed. Participants of the control group were not tilted and asked not to lie down.

“The results of the COVI-PRONE trial have improved our understanding of the efficacy and safety of waking positioning in patients with COVID-19,” Alhazani added.

The results of the COVI-PRONE test were published on May 15 JAMA. On the same day, Alhazani presented the results at the International Conference of the American Thoracic Society in San Francisco.

The Intensive Care, Development and Evaluation Guidance (GUIDE) team at St. Joseph’s Medical Institution in Hamilton, which is developing sound evidence of clinical practice, has begun to re-evaluate the guidelines for placement on the slope.

“St. Joe’s GUIDE Group is conducting an updated systematic review and meta-analysis to assess the effectiveness and harm of waking placement for patients with hypoxemia respiratory failure“Said Sarah Colgin, co-author of the study and research manager at the St. Joe Hamilton Research Institute. “Including more recent data, such as COVI-PRONE, may affect the overall picture of the predisposition effect of this patient population.”

Lying down can be a time consuming procedure as it requires physical maneuvering of patients and close monitoring. Due to the fact that hospitals were overcrowded during the pandemic, future GUIDE Group recommendations are likely to affect how sloping location is used and how staff resources are used.

Several COVI-PRONE investigators are in and around Hamilton, including Walid Alhazani, Eric Dwan, Jennifer Tsang, Kimberly Lewis, Bram Rohverg, Maureen Mead, Dan Perry, Emily Belly-Kote, Deborah Cook, John Centofanta, John Saint Sarah Calgin and Kate Nelson.

The GUIDE group is co-chaired by two COVI-PRONE investigators, Walid Alhazani and Emily Belli-Cote.

“Conducting clinical trials of placing patients on a slope during a pandemic – with patients with COVID-19 – was in itself a feat,” Kalgin said. “We are grateful to have had such a collaborative network of clinicians and scientists coming together to make this happen.”