lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

Self-Proning in COVID-19 Patients on Low-Flow Oxygen Therapy: A Cluster Randomised Controlled Trial

21 Pages Posted: 21 Oct 2020

See all articles by Aileen Kharat

Aileen Kharat

Geneva University Hospitals - Division of Lung Diseases

Elise Dupuis-Lozeron

Geneva University Hospitals - Division of Clinical Epidemiology

Chloé Cantero

Geneva University Hospitals - Division of Lung Diseases

Christophe Marti

University of Geneva - Medical School

Olivier Grosgurin

Geneva University Hospitals - Division of Internal Medicine

Sanaz Lolachi

Geneva University Hospitals - Division of Internal Medicine

Frédéric Lador

Geneva University Hospitals - Division of Lung Diseases

Jérôme Plojoux

Geneva University Hospitals - Division of Lung Diseases

Jean-Paul Janssens

Geneva University Hospitals - Division of Lung Diseases

Paola Soccal

Geneva University Hospitals - Division of Lung Diseases

Dan Adler

Geneva University Hospitals - Division of Lung Diseases

More...

Abstract

Rationale: Prone positioning as a complement to oxygen therapy to treat hypoxemia in coronavirus disease (COVID-19) pneumonia in spontaneously breathing patients has been widely adopted, despite a lack of evidence for its benefit.

Objectives: To test the hypothesis that a simple incentive to self-prone for a maximum of 12 h per day would decrease oxygen needs in patients admitted to the ward for COVID-19 pneumonia on low-flow oxygen therapy. 

Methods: Twenty-seven patients with confirmed COVID-19 pneumonia admitted to Geneva University Hospitals were included in the study. Ten patients were randomised to self-prone positioning and 17 to usual care. 

Measurements and Main Results: Oxygen needs assessed by oxygen flow on nasal cannula at inclusion were similar between groups. Twenty-four hours after starting the intervention, the median oxygen flow was 1·0 L/min (interquartile range, 0·1-2·9) in the prone position group and 2·0 L/min (interquartile range, 0·5-3·0) in the control group (P = 0·507). Median oxygen saturation/fraction of inspired oxygen ratio was 390 (interquartile range, 300-432) in the prone position group and 336 (interquartile range, 294-422) in the control group (P = 0·633). One patient from the intervention group who did not self-prone was transferred to the high-dependency unit. Self-prone positioning was easy to implement. The intervention was well tolerated and only mild side-effects were reported. 

Conclusions: Self-prone positioning in patients with COVID-19 pneumonia requiring low-flow oxygen therapy resulted in a clinically meaningful reduction of oxygen flow, but without reaching statistical significance.

Trial Registration: The study was registered on the Swiss National Clinical Trial portal (SNCTP000003718).

Funding Statement: None.

Declaration of Interests: None.

Ethics Approval Statement: The institutional ethics review committee approved the trial (CCER 2020-00705). All participants provided written informed consent before screening.

Keywords: prone position, coronavirus disease, pneumonia, oxygen therapy

Suggested Citation

Kharat, Aileen and Dupuis-Lozeron, Elise and Cantero, Chloé and Marti, Christophe and Grosgurin, Olivier and Lolachi, Sanaz and Lador, Frédéric and Plojoux, Jérôme and Janssens, Jean-Paul and Soccal, Paola and Adler, Dan, Self-Proning in COVID-19 Patients on Low-Flow Oxygen Therapy: A Cluster Randomised Controlled Trial. Available at SSRN: https://ssrn.com/abstract=3692538 or http://dx.doi.org/10.2139/ssrn.3692538

Aileen Kharat

Geneva University Hospitals - Division of Lung Diseases ( email )

Switzerland

Elise Dupuis-Lozeron

Geneva University Hospitals - Division of Clinical Epidemiology

Geneva
Switzerland

Chloé Cantero

Geneva University Hospitals - Division of Lung Diseases ( email )

Switzerland

Christophe Marti

University of Geneva - Medical School ( email )

Geneva
Switzerland

Olivier Grosgurin

Geneva University Hospitals - Division of Internal Medicine ( email )

Geneva
Switzerland

Sanaz Lolachi

Geneva University Hospitals - Division of Internal Medicine ( email )

Geneva
Switzerland

Frédéric Lador

Geneva University Hospitals - Division of Lung Diseases ( email )

Switzerland

Jérôme Plojoux

Geneva University Hospitals - Division of Lung Diseases ( email )

Switzerland

Jean-Paul Janssens

Geneva University Hospitals - Division of Lung Diseases ( email )

Switzerland

Paola Soccal

Geneva University Hospitals - Division of Lung Diseases ( email )

Switzerland

Dan Adler (Contact Author)

Geneva University Hospitals - Division of Lung Diseases ( email )

Switzerland

Click here to go to TheLancet.com

Paper statistics

Abstract Views
391
Downloads
35
PlumX Metrics