Effect of proning in patients with COVID-19 acute hypoxemic respiratory failure receiving non-invasive oxygen therapy: A prospective cohort study

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, Hubei Province China, and has subsequently spread worldwide in more than 200 countries including India. Although majority of patients have a favourable prognosis, the older age group, and presence of chronic diseases have been reported to have worse outcomes. Severe illness is marked by development of dyspnea, hypoxemia and progression to acute respiratory distress syndrome (ARDS) within one week of onset of symptoms (1). The most documented reason for requiring intensive care has been respiratory support, of which two-thirds of patients have met criteria for acute respiratory distress syndrome. Care of critically ill patients of COVID 19 is resource intensive, especially important in developing nations like India. Use of non-invasive methods of oxygen deliverywith high flow nasal cannula(2) and non-invasive ventilation(3,4) is an option in mild to moderate ARDS and may reduce the need for invasive mechanical ventilation. Any intervention which may result in reducing the need for intubation and mechanical ventilation can have a major impact in resource conservation in a pandemic situation.The aim of our study is to determine whether the early use of prone positioning (PP) combined with oxygen by non-rebreather mask (NRBM), non-invasive ventilation (NIV) or high-flow nasal cannula (HFNC) can avoid the need for intubation mild to moderate ARDS.