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Respiratory Parameters in Patients With COVID-19 After Using Noninvasive Ventilation in the Prone Position Outside the Intensive Care Unit

Educational Objective
To understand the effects of using proning during Noninvasive ventilation when treating COVID-19 patients.
1 Credit CME

The pandemic of coronavirus disease 2019 (COVID-19), with a large number of patients requiring respiratory support, threatens to overload intensive care units (ICUs). Noninvasive ventilation (NIV) use in general wards may be an alternative for some patients but has seldom been described and is not used worldwide.1 One study described the feasibility of NIV in the prone position2; pronation can recruit dorsal lung regions and drain airway secretions, improving gas exchange and survival in acute respiratory distress syndrome (ARDS).3 We report respiratory parameters after using this intervention in a case series of patients with COVID-19.

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Article Information

Corresponding Author: Giovanni Landoni, MD, Vita-Salute San Raffaele University, Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60-20132, Milan, Italy (landoni.giovanni@hsr.it).

Accepted for Publication: April 27, 2020.

Published Online: May 15, 2020. doi:10.1001/jama.2020.7861

Author Contributions: Dr Landoni had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Sartini, Tresoldi, Landoni, Zangrillo.

Acquisition, analysis, or interpretation of data: Sartini, Scarpellini, Tettamanti, Francesco, Landoni.

Drafting of the manuscript: Sartini, Landoni.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Sartini.

Administrative, technical, or material support: Sartini, Francesco, Zangrillo.

Supervision: Sartini, Tresoldi, Landoni, Zangrillo.

Additional Contributions: We thank all the medical staff, residents, and nurses of San Raffaele Hospital, especially Francesco Nisi, MD, for careful data collection; Colombo Sergio, MD, and Monti Giacomo, MD, for their support to other colleagues due to clinical expertise in noninvasive ventilation; Silvani Paolo, MD, for his role as coordinator of all the medical emergency teams; Cristallo Edoardo, MD, and Tarzia Valentina, MD, for their first-line help in the management of noninvasive ventilation; and Castelli Elena, DPT, for her contribution in the physical rehabilitation of these patients. None mentioned herein received any compensation for their contribution.

References
1.
Cabrini  L , Landoni  G , Bocchino  S ,  et al.  Long-term survival rate in patients with acute respiratory failure treated with noninvasive ventilation in ordinary wards.   Crit Care Med. 2016;44(12):2139-2144. doi:10.1097/CCM.0000000000001866PubMedGoogle ScholarCrossref
2.
Ding  L , Wang  L , Ma  W , He  H .  Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-center prospective cohort study.   Crit Care. 2020;24(1):28. doi:10.1186/s13054-020-2738-5PubMedGoogle ScholarCrossref
3.
Guérin  C , Reignier  J , Richard  JC ,  et al; PROSEVA Study Group.  Prone positioning in severe acute respiratory distress syndrome.   N Engl J Med. 2013;368(23):2159-2168. doi:10.1056/NEJMoa1214103PubMedGoogle ScholarCrossref
4.
Rice  TW , Wheeler  AP , Bernard  GR , Hayden  DL , Schoenfeld  DA , Ware  LB ; National Institutes of Health, National Heart, Lung, and Blood Institute ARDS Network.  Comparison of the Spo2/Fio2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS.   Chest. 2007;132(2):410-417. doi:10.1378/chest.07-0617PubMedGoogle ScholarCrossref
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