Determination of the Effect of the Fowler and Prone Position on Oxygen Saturation in Patients Diagnosed with COVID-19

Year 2023, Volume: 13 Issue: 1, 159 - 165, 28.03.2023

Yeşim İşler Işıldak , Fatma Eti Aslan , Goknur Parlak

https://doi.org/10.33808/clinexphealthsci.1186086

Abstract

Objective: This study was conducted to investigate the effect of the Fowler position and prone position on oxygen saturation in patients receiving treatment in clinics with the diagnosis of COVID-19 disease.
Method: A total of 40 patients, admitted to the pandemic ward who met the inclusion criteria, were included in the quasi-experimental type study without any sampling. The patients were first given the Fowler position and then the prone position. There was a time interval of 15 minutes wait between the two positions. For each position, peripheral oxygen saturation, heart rate, respiratory and blood pressure values were obtained at initial position placement, after the 30th minute and every hour for the first four hours.
Results: The mean age of the participants was 57.57±12.64 years. Respiratory distress, cough, fever, weakness, sweating and headache were the main symptoms. A total of 22.5% of them had a diagnosis of hypertension and Diabetes Mellitus. The requirement for the positioning was found to be 95% in the first five days after admittance. After treatment, 85% of them were discharged home. The mean oxygen saturation values of the patients for every hour in the Prone position were 93.15±1.718 (p=0.035), 93.60±1.809 (p=0.019), 93.93±1.774 (p=0.006) and 94.15±1.718 (p=0.002), respectively in the first four hours. These findings were statistically significant compared to the Fowler position. Respiratory values
in the prone position were 17.30±1.159 (p=0.005), 17.20±1.344 (p=0.010), 17.20±1.181 (p=0.005), and 17.05±1.280 (p=0.001), respectively in the first four hours, which were statistically lower than in the Fowler position. There was no significant difference in the mean heart rate and blood pressure in both positions (p>0.05).
Conclusion: The prone position was found to have a positive effect on oxygen saturation levels when Fowler and Prone positions were applied in patients receiving treatment with the diagnosis of COVID-19 in hospital wards. Therefore, it is recommended that patients admitted with the diagnosis of COVID-19 be placed in the prone position at regular intervals.

Keywords

COVID-19, Prone position, Fowler position, Oxygen Saturation

References

• Özbilen F, Altunkan AA. COVID-19 and awake prone position. Turk J Intensive Care 2020;18:50-56 (Turkish).
• Rollas K, Şenoğlu N. Management of Covid-19 patients in intensive care unit. Tepecik Eğit. ve Araşt. Hast. Dergisi 2020;30:142-155 (Turkish).
• Akyar I. COVID-19 hastalarında Akut Solunum Sıkıntısı Sendromu (ARDS) yönetimi ve hemşirelik bakımı. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi. 2020;7:8-14 (Turkish).
• Goh KJ, Choong MCM, Cheong EHT, Kalimuddin S, Wen DS, Phua GC. Rapid progression to acute respiratory distress syndrome: Review of current understanding of critical illness from coronavirus disease 2019 (COVID-19) infection. Ann Acad Med Singap. 2020;49:108-118.
• Yalçın A. COVID-19 sürecinde yoğun bakım yönetimi. Med Res Rep. 2020;3:66-85 (Turkish).
• Wu ZY, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239 – 1242.
• Uzelli Yılmaz D, Ceylan B, Yıldırım D, Karatekin Erkut D, Akın Palandöken E. Care priorities and critical nursing interventions in patients with COVID-19: Four different case reports. Izmir Kâtip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 2020;5:235-242. (Turkish).
• Türkiye enfeksiyon hastaliklari ve klinik mikrobiyoloji uzmanlik derneği. COVID-19 erişkin hasta yönetimi ve tedavisi. Available from https://www.ekmud.org.tr/haber/328-eriskin-hastayonetimi- vetedavisi-COVID-19 – virus-algoritmalari. Sept 21,2021.
• Kansu A. Covid 19 pandemisinde akciğer ve göğüs hastalıkları. Med Res Rep 2020;3:11-16 (Turkish).
• Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ. An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2017;195:1253-1263.
• Gürün Kaya A, Öz M, Erol S, Çiftçi F, Çiledağ A. Kaya A. Prone positioning in non – intubated patients with COVID-19. Tuberk Toraks 2020;68:331-336.
• Anchala AM. A study to assess the effect of therapeutic positions on hemodynamic parameters among critically ill patients in the intensive care unit at Sri Ramachandra medical centre. J Nurs Care 2016;5:1000348.
• Scholten EL, Beitler JR, Prisk GK, Malhotra A. Treatment of ARDS with prone positioning. Chest 2017;151:215-224. Gattinoni L, Taccone P, Carlesso E, Marini JJ. Prone position in acute respiratory distress syndrome. Rationale, indications, and limits. Am J Respir Crit Care Med 2013;188:1286-1293.
• Jiang LG, LeBaron J, Bodnar D, Caputo ND, Chang BP, Chiricolo G. Conscious proning: An introduction of a proning protocol for nonintubated, awake, hypoxic emergency department COVID-19 patients. Acad Emerg Med 2020;27:566-569.
• Kocayigit H, Ülgen AM, Tuna Tas A. Respiratory failure management in the patient with COVID-19 in intensive care. Journal of Human Rhythm 2020;6:101-107.
• Çapık C. İstatistiksel güç analizi ve hemşirelik araştırmalarında kullanımı: Temel bilgiler. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi 2014;17:4 (Turkish).
• Cohen J. Statistical power analysis. Curr Dir Psychol Sci 1992;1:98-101.
• Des Jarlais DC, Lyles C, Crepaz N, the Trend Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement. Am J Public Health 2004;94:361-366.
• Qadri SK, Ng P, Toh TSW, Loh SW, Tan HL, Lin CB. Critically ill patients with COVID-19: A narrative review on prone position. Pulm Ther 2020;6:233-246.
• Tuncer M, Khorshtd L. The effect of positions on oxygen saturation in obese individuals. Ege Üniversitesi Hemşirelik Fakültesi Dergisi 2018;34:54 – 65 (Turkish).
• Hayran M, Hayran M. Sağlık Araştırmaları Için Temel Istatistik. 1. Basım. Ankara: Omega Araştırma; 2011 (Turkish).
• Büyüköztürk Ş. Veri Analizi El Kitabı. Ankara: Pegem Akademi; 2011 (Turkish).
• Xu Q, Wang T, Qin X, Jie Y, Zha L, L We. Early awake prone position combined with high-flow nasal oxygen therapy in severe COVID-19: A case series. Crit Care 2020;24:250.
• Ding L, Wang L, Ma W, He H. Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: A multi-center prospective cohort study. Crit Care 2020;24:28.
• Elharrar X, Trigui Y, Dols AM, Touchon F, Martinez S, Prud’homme E. Use of prone positioning in nonintubated patients with COVID-19 and hypoxemic acute respiratory failure. JAMA 2020;323:2336-2338.
• Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): A prospective cohort study. Lancet Respir Med 2020;8:765-774.
• Golestani-Eraghi M, Mahmoodpoor A. Early application of prone position for management of Covid-19 patients. J Clin Anesth 2020;66:109917.
• Solverson K, Weatherald J, Parhar KKS. Tolerability and safety of awake prone positioning COVID-19 patients with severe hypoxemic respiratory failure. J Can Anesth 2021;68:64-70.
• Nakos G, Tsangaris I, Kostanti E, Nathanail C, Lachana A, Koulouras V. Effect of the prone position on patients with hydrostatic pulmonary edema compared with patients with acute respiratory distress syndrome and pulmonary fibrosis. Am J Respir Crit Care Med 2000;161:360-368.
• Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E. Surviving sepsis campaign: Guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). Crit Care Med 2020;48:e440-e469.
• World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance. Available from https://www.who.int/docs/default-source/ coronaviruse/clinicalmanagement-of-novel – cov. pdf. Apr 6, 2020.
• Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single – centered, retrospective, observational study. Lancet Respir Med. 2020; 8:475-481.
• Thompson AE, Ranard BL, Wei Y, Jelic S. Prone positioning in awake, nonintubated patients with COVID-19 hypoxemic respiratory failure. JAMA Intern Med 2020;180:1537-1539.