Patients self-proning with high-flow nasal cannula improves oxygenation in mild ARDS patients: a randomized clinical trial

Abstract

Background & Objective: Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of
tachypnea, hypoxemia, and loss of lung compliance. Clinicians have employed various means to improve
oxygenation in these patients. We evaluated the effect of self-proning with a high-flow nasal cannula in patients
with ARDS on oxygenation and the incidence of intubation.
Methodology: Ninety patients, aged above 18 y old, patients with BMI below 30 kg/m2, from both genders, suffering from COVID-19 and mild ARDS, participated in this prospective, randomized, double-blind clinical trial at Ain Shams University hospitals. Participants were allocated into two equal groups; Group 1: Patients were subjected to HFNC with a target SpO2 ≥ 90% with FiO2 < 0.6. Group 2: Patients were subjected to HFNC with a target of SpO2 > 90% with FiO2 ≤ 0.6, and combined with self proning. Upon ICU admission, age, weight, BMI, sex, baseline PcO2/FiO2 (P/F) ratio, baseline SpO2 and baseline heart rate were noted. During ICU stay, hemodynamic data and respiratory rate, ABG’s were recorded on admission and every six hours after therapy 6, 12, 24, 48, and 96 h till the patient was discharged from ICU. CXR was obtained on admission and at 24 h, and assessed by Berlin criteria. Assuming a rate of intubation of 50% in the group without prone position setting power at 80% and alpha error at 0.05, a sample size of 45 patients per group was needed.
Results: HFNC with proning was effective in improving oxygenation of the mild ARDS patients and decreasing the incidence of intubation; 11 patients in Group 1 and 4 in Group 2 needed to be intubated. Regarding mortality 35 patients survived in Group 1 compared to 42 in Group 2. The median ICU stay was significantly shorter in Group II, 12 (10–12) days compared to Group I, 19 (18–21); P = 0.000.
Conclusion: The use of high-flow nasal cannula and proning reduced the frequency of intubation in mild ARDS
patients in ICU, and also decreased the ICU stay and improved the outcome of patients with mild ARDS.
Abbreviations: ARDS: Acute Respiratory Distress Syndrome; ICU: Intensive Care Unit; HFNC: High-Flow Nasal
Cannula; NIV: Non-Invasive Ventilation
Key words: Acute Respiratory Distress Syndrome; COVID-19; High Flow Nasal Cannula; Proning. Nasrallah BZN, et al Patients self-proning with high-flow nasal cannula www.apicareonline.com 352 Open access attribution (CC BY-NC 4.0)
Citation: Nasrallah BZN, Mahmoud MS, Abdallah ElGendy HM, Youssri Mahmoud NM, Aly ElGendy MAE. Patients self-proning with high-flow nasal cannula improves oxygenation in ARDS patients: a randomized clinical trial. Anaesth. pain intensive care 2023;27(3):351−355; DOI: 10.35975/apic.v27i3.2079
Received: November 23, 2022; Reviewed: December 22, 2022; Accepted: April 08, 2023