Effectiveness of prone ventilation in awake, non-in tubated covid 19 patients in a tertiary care centre in Rajasthan

Background: India witnessed a disaster in the form of covid in 2020-21 crippling the healthcare system like never before. With multiple waves happening consecutively with unexpected death rates, hospitals couldn’t make arrangements for the overspill from the ICU under such short notice. Awake proning which is an accepted treatment modality for mechanically ventilated ARDS patients was adopted into the treatment protocol of most of the hospitals with the hypothesis that it would delay the escalation of respiratory support, ICU admissions ad intubation. Methods: We conducted a longitudinal study and evaluated the effectiveness of awake proning in terms of improvement in oxygen saturations, incidence of ICU admissions and death rates in non-intubated patients managed in general covid care wards. Chi square test and paired t test was applied for statistical analysis. Results: All patients who could tolerate prone positioning for at least an hour had significant improvement in oxygen saturation with significant decrease in ICU admissions and death rates. The death rate among successfully proned patients were 6.4% in comparison to 66.6% in patients who couldn’t maintain prone. Best results were obtained in patients who tolerated prone positioning for more than 1 hour. Conclusions: Incorporating awake proning into the treatment protocol has significantly reduced the freight on Intensive care units by being able to manage notable number of patients in the general wards.