August Global intensive care study offers new treatment approach for critically-ill Covid-19 patients

NUI Galway sponsored research demonstrates that clinicians should treat patients on their stomachs

Critically-ill Covid-19 patients are less likely to die or to require invasive ventilation if lying prone on their stomachs while receiving oxygen, a global research project sponsored by NUI Galway has found.

The impact of the technique, known as awake prone positioning, was assessed in hospitals in six countries on more than 1,000 coronavirus patients requiring advanced breathing support.

The findings are published in The Lancet Respiratory Medicine.

The study was the first clinical trial of its kind into the practice of awake prone positioning and ran from April 2020 to January 2021. It showed that treating patients in this position, while they received high flow nasal cannula oxygen, reduced death and the need for invasive mechanical ventilation.

Dr Bairbre McNicholas, Honorary Senior Lecturer at NUI Galway and Intensive Care Consultant at University Hospital Galway, said: “Providing an evidence base for what we do in the intensive care unit is critical so that we support and implement recommendations that work.

“This study, which was part of a global effort and was sponsored locally by NUI Galway and the Health Research Board-Clinical Research Facility Galway, as part of its response to the Covid-19 pandemic, shows that clinical trials can be scaled up and done properly and efficiently during a pandemic and demonstrates what we can achieve when we work together.”

The study involved 1,121 patients in the US, Canada, Mexico, France, Spain and Ireland, and it is the first time awake prone positioning has been studied to such an extent.

Some of the key findings:

:: Awake prone positioning reduces death and the need for invasive intubation in patients with severe Covid-19 who require high flow nasal cannula oxygen.

:: The technique is safe and well tolerated by patients.

:: Blood oxygen levels are significantly improved in patients who adopt awake prone positioning.

:: The longer patients can sustain being in prone positioning, the greater the success of the treatment and the less likely they were to need invasive mechanical ventilation.

:: Given the scarcity of ventilators and oxygen therapy, particularly in low and middle income countries, this study provides welcome data on the efficacy of awake prone positioning which will ensure that the low-cost strategy to invasive mechanical ventilation is supported as a treatment strategy.

Dr McNicholas said: “I tell patients that going on your tummy will improve the oxygen levels in your blood, that although it is uncomfortable, the longer you can put up with this position, the less likely you will need to go onto require needing a breathing tube.”

Lisa Power was treated using awake prone positioning while being treated at University Hospital Galway for Covid-19.
Ms Power said: “I am extremely grateful to all the staff at University Hospital Galway, particularly the medics in ICU and especially as I was awake proned. It really helped my breathing and made me much more comfortable without having to put me on a ventilator. I cannot thank the staff enough for all the care they provided.”

Professor Tim O’Brien, Executive Dean of the College of Medicine, Nursing and Health Sciences, NUI Galway and Consultant Physician in Endocrinology and Metabolism, Saolta University Hospital Group, said: “Given the scarcity of ventilators and oxygen therapy, particularly in low and middle income countries, this study provides welcome data on the efficacy of awake prone positioning which will ensure that it is supported as a treatment strategy.

“NUI Galway’s approach to global medicine is based on effective collaboration and on bringing together some of the best minds to solve the healthcare challenges of today. Using a new approach, called a meta-trial, teams from around the world united data in a pre-planned analysis from inception. This enabled an accelerated trial with a large number of patients - a global collaborative methodology that is essential during a pandemic.”

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