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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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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 (email@example.com).
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.
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