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Efficacy, safety and tolerability of early prone positioning in COVID-19 patients requiring high-flow nasal cannula: a case report.

Miquel Sanz-Moncusi, Rosselló-Sancho J, Garcia-Alamino JM

A recent study shows the efficacy of early prone positioning (PP) in patients with acute respiratory distress syndrome (ARDS) requiring high flow nasal cannula (HFNC) or non-invasive mechanical ventilation. The effects of PP in Covid-19 patients on HFNC have not been reported. Case Report: A 54-year-old man was admitted to our University Hospital with fever (39ºC) for eight days and progressive shortness of breath within the last 24h. A chest X-ray revealed bilateral infiltrates. Nasopharyngeal smear PCR for SARS-CoV-2 was positive. The patient was admitted to the ICU due to the progressive hypoxemia that required HFNC (FiO2 80%; 60 liters per minute). The patient rotated into lateral and PP for 4 hours each day for 4 days. Rotations to lateral and PP were well tolerated and improved markedly the PaO2/FiO2 ratio. Five days after ICU admission HFNC was changed by a venturi mask (FiO2 40%). Conclusion: Awake prone and lateral positioning is well tolerated in COVID-19 patients requiring HFNC and could prevent invasive mechanical ventilation. This technique is simple and requires a very short learning curve, feature that represents a major advantage in a pandemic scenario, in which inexperienced healthcare professionals are treating an increasing number of severely ill patients.