A Single Intensive Care Experience for Early Awake Proning in A Non-Intubated Patient During the COVID-19 Pandemic

Document Type : Case Report

Authors

1 Department of Anesthesia and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

2 Department of Internal Medicine, Zulekha Hospital, Dubai, United Arab of Emirates.

3 Department of Critical Care Medicine, Zulekha Hospital, Dubai, United Arab of Emirates.

4 Department of Pulmonology, Zulekha Hospital, Dubai, United Arab of Emirates.

5 Department of Radiology, Zulekha Hospital, Dubai, United Arab of Emirates.

Abstract

Background: Proning is an evidence-based method that has been used frequently in patients diagnosed with ARDS. There is scarce evidence on the prone positioning of alert patients who are not on a mechanical ventilator.
Case presentation: A 59-year-old male patient presented to the emergency room complaining of respiratory distress. The findings from the CT scan was consistent with coronavirus pneumonia. The patient tested positive for SARS- Cov-2 after RT-PCR amplification testing. The laboratory findings were within the normal limits apart from the partial arterial oxygen pressure [PaO2] which was relatively low. The patient was started on Favipiravir, multivitamins, anti-PUD, and anti-DVT prophylaxis. The patient was transferred to ICU on the 2nd day on NIMV because of deoxygenation and started on Methylprednisolone, Interferon Alpha 2B, Camostat mesylate, and Levofloxacine. The patient was instructed to be in a proning position. A sample of arterial blood gas [ABG] was taken two and three hours following proning, and throughout the patient’s stay in the ICU, the findings revealed perfect outcomes during the prone position. As a result, the patient was transferred from the ICU to the normal ward. On the 21st day after hospital admission, the patient was discharged.
Conclusion: Prone positioning is associated with improved oxygenation as reported in several case reports and case series.

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