CHICAGO — A new study aims to see if placing hospital patients facedown and giving them oxygen will help treat breathing problems caused by the novel coronavirus, thereby reserving ventilators for more severe cases.
The clinical trial at Rush University Medical Center in Chicago calls for patients to lie facedown on their beds for 16 hours at a time, with heated, humidified oxygen flowing in through tubes in their noses.
Some COVID-19 patients have preexisting conditions such as asthma or lung disease, and almost 1 out of 3 COVID-19 patients may develop acute respiratory distress syndrome, study sponsors said. Fluid may leak into the lungs, causing hypoxemia, or low levels of oxygen in the blood, which can lead to shortness of breath. The condition can be fatal and may leave survivors with weakness, fatigue and a decreased quality of life.
A high-flow nasal cannula, or tube, has been proved to improve oxygenation and avoid intubation for some patients, Rush officials said. Previous studies suggest that placing patients in the prone position, but with the bed angled to keep the head slightly up, can improve breathing and reduce mortality.
At Rush, doctors were treating about 160 patients with COVID-19 last week, with more being transferred in from other hospitals. Roughly half require mechanical ventilation to help them breathe.
Doctors have been putting some patients in the prone position already and have seen some begin to improve within minutes or in an hour or two, said David Vines, director of the respiratory care program at Rush.
“We’ve found it hugely beneficial,” Vines said. “We are optimistic that this would reduce the number of patients that move to mechanical ventilation.”
Intubation and ventilation can save lives, but may also allow pneumonia to develop, which can prove fatal, so the decision whether to use it is always a sensitive one, Vines said. One recent study in the United Kingdom found that of 98 COVID-19 patients who required advanced respiratory support, including ventilation, 2 out of 3 died.
Patients who agree to participate in the Rush study will be randomly assigned by computer to either lie in the prone position or not.
A team of six medical workers, including a respiratory therapist and a nurse, will work together to turn over the patients as necessary, with 16 hours prone followed by four hours supine, or on their backs. Turning patients over may be tricky if they have multiple medical tubes attached to their bodies.
Patients will be watched to try to prevent potential complications, such as injuries to their nose or lips from the tube, or a buildup of fluid in their airways.
Vines is not a physician but is chair of the Department of Cardiopulmonary Sciences, with expertise in mechanical ventilation and critically ill patients. He was once the Illinois Society for Respiratory Care’s Practitioner of the Year. He teaches classes and helps treats patients as well. Like other medical workers, he has been slammed with work in the past few weeks since the pandemic spread locally.
The first patient in the study was recruited Wednesday, with more to come as the trial continues through April.
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