Implementing an Awake Proning Protocol for COVID-19 Patients with Moderate Hypoxia in the Emergency Department

Background: New York City emergency departments (EDs) faced a sudden influx of critically ill patients during the initial wave of COVID-19, leading to a shortage of resources to care for patients experiencing hypoxia. This study describes the development and implementation of an awake proning protocol in which conscious patients with suspected or confirmed COVID-19 moderate hypoxia were assisted to a prone position to improve oxygenation.

Methods: This one-week project took place in a single New York City ED. An interdisciplinary team of nursing and medical leadership reviewed the literature on the safety and effectiveness of awake proning and developed a treatment protocol and seven-member interdisciplinary proning team. Oxygenation (SpO2), heart rate (HR), and respiration rate (RR) were recorded at baseline and 10-minutes post-proning.

Results: Thirty patients were included. Mean age was 60.8 and a majority were male (n = 25; 83%). Significant differences between pre- and post-proning measures were found for SpO2 (p < 0.000), HR (p < 0.028), and RR (p < 0.025) after 10 minutes of awake proning.

Conclusion: Awake proning is a promising technique for improving outcomes in patients with respiratory distress and can be implemented effectively in an ED setting.