P53 The role of a ‘multidisciplinary proning team’ in managing SARS-Cov-2 patients with hypoxemic respiratory failure on an acute respiratory care unit

BackgroundEarly awake proning (EAP) in SARS-CoV-2 as an intervention outside of intensive care unit (ICU) is gaining interest but large scale studies are lacking Anticipating a significant surge in SARS-CoV-2 related admissions and to reduce the burden on ICU, we developed a dedicated ‘multidisciplinary proning team’ (MPT) consisting of respiratory physiotherapists and Acute Respiratory Care Unit (ARCU) staff who undertook this intervention MethodPatients with either suspected or confirmed SARS-CoV-2 with worsening hypoxemia (PaO2 6 5) were admitted to ARCU for consideration of respiratory support Along with the standard supportive measures, patients were also assessed for EAP and suitable patients were proned driven by patients’ preference This was led by the MPT Patient demographics, Length of stay (LOS), clinical characteristics, proning duration and outcomes between survivors and non- survivors were evaluated Results39 patients [age: mean ± SD= 63±16, males-64%] were proned on 99 sessions [median (IQR) = 2 (1–4) sessions per patient, each session lasting for 2–4 hours] The median (IQR) LOS was 5 (4–9) days Patients who survived were significantly younger as compared to those who did not survive (55 years v/s 69 years, P= 0 007) There was a significant difference in the saturations at admission (96% v/s 91%, P= 0 04;mean diff= -4 38) and Sp02 change on proning was similar between survivors and non-survivors (Δ 5%,P=0 46) Majority of patients in both the groups were managed with CPAP + PS but patients who survived required a lower supplemental fio2 as compared to those who did not survive (55% v/s 70%, P= <0 0001, mean diff= 22%) Overall proning failure was 10% and there was no difference in baseline RR, ABG measurements and specific SARS-Cov-2 blood parameters DiscussionEAP may be considered outside of ICU and a dedicated proning team may be helpful Further large scale studies are warranted to evaluate the various effects of awake proning Age at presentation and the degree of hypoxemia are vital factors when assessing and managing patients