Early Self-Proning in Awake, Non-intubated Patients in the Emergency Department: A Single ED's Experience During the COVID-19 Pandemic
Early Self-Proning in Awake, Non-intubated Patients in the Emergency Department: A Single ED's Experience During the COVID-19 Pandemic
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DOI：
10.1111/acem.13994
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发表时间：
2020-05-01
影响因子：
4.4
通讯作者：
Levitan, Richard
中科院分区：
文献类型：
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作者：
Caputo, Nicholas D.;Strayer, Reuben J.;Levitan, Richard
目的 长期缺氧且未得到解决可能会导致患者预后不佳。俯卧位已成为治疗难以达到足够氧饱和度的 ARDS 患者的标准治疗方法。本研究的目的是描述在 COVID-19 大流行期间急诊科 (ED) 中清醒、非插管患者早期俯卧的使用情况。 方法 这项试点研究是在纽约市的一个城市急诊室进行的。我们纳入了疑似患有 COVID-19 且抵达时缺氧的患者。使用标准脉搏血氧计测量 SpO(2)。在分类时和俯卧 5 分钟后记录 SpO(2) 测量值。补充氧合方法包括非重复呼吸面罩（NRB）和鼻插管。我们还对到达急诊室后前 24 小时内插管后的失败率进行了分析。结果 纳入了 50 名患者。总体而言，分诊时 SpO(2) 中位数为 80%（IQR 69 至 85）。在通过室内空气给患者补充氧气后，该比率为 84%（IQR 75 至 90）。添加俯卧 5 分钟后，SpO(2) 改善至 94%（IQR 90 至 95）。通过 Wilcoxon Rank-sum 检验比较前后中位数得出 P = 0.001。 13 名患者 (24%) 未能改善或维持血氧饱和度，需要在到达急诊室后 24 小时内进行气管插管。 结论 在急诊科早期觉醒自我俯卧证明我们的 COVID-19 阳性患者的血氧饱和度有所改善。需要进一步的研究来支持因果关系并确定俯卧对疾病严重程度和死亡率的影响。
Objective Prolonged and unaddressed hypoxia can lead to poor patient outcomes. Proning has become a standard treatment in the management of patients with ARDS who have difficulty achieving adequate oxygen saturation. The purpose of this study was to describe the use of early proning of awake, non-intubated patients in the emergency department (ED) during the COVID-19 pandemic.Methods This pilot study was carried out in a single urban ED in New York City. We included patients suspected of having COVID-19 with hypoxia on arrival. A standard pulse oximeter was used to measure SpO(2). SpO(2) measurements were recorded at triage and after 5 minutes of proning. Supplemental oxygenation methods included non-rebreather mask (NRB) and nasal cannula. We also characterized post-proning failure rates of intubation within the first 24 hours of arrival to the ED.Results Fifty patients were included. Overall, the median SpO(2) at triage was 80% (IQR 69 to 85). After application of supplemental oxygen was given to patients on room air it was 84% (IQR 75 to 90). After 5 minutes of proning was added SpO(2) improved to 94% (IQR 90 to 95). Comparison of the pre- to post-median by the Wilcoxon Rank-sum test yielded P = 0.001. Thirteen patients (24%) failed to improve or maintain their oxygen saturations and required endotracheal intubation within 24 hours of arrival to the ED.Conclusion Awake early self-proning in the emergency department demonstrated improved oxygen saturation in our COVID-19 positive patients. Further studies are needed to support causality and determine the effect of proning on disease severity and mortality.