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Prone PositionNCT04760561

Awake Prone Positioning for Non-intubated COVID-19 Patients

A study testing prone position group in people with Prone Position and Coronavirus Disease 2019, run by Damanhour University at 1 site in Egypt.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The burden of coronavirus disease 2019 (COVID-19) pandemic is still on a rising course making a great stress on medical resources throughout the world. Although most of COVID-19 patients require non-invasive oxygenation and ventilation, rapid progression to hypoxemic respiratory failure and then acute respiratory… Read more about this study

Who is it for?
Ages 18 to 75 years
What is being tested?
prone position group
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
82 participants
Where
1 siteEgypt
Study dates
20 Feb 2021to 20 Apr 2021
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Aged 18-75 years old
  • Awake non-intubated spontaneously breathing patients
  • Confirmed diagnosis of severe COVID-19; manifesting as dyspnea with respiratory rate ≥ 30 breaths/min, pulse rate ≥ 100 beats/min, oxygen saturation ≤93%, or partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2) ratio ≤ 150 mmHg.
  • Positive RT-PCR for SARS-CoV-2 from analysis of nasopharyngeal, oropharyngeal swab, or tracheal secretion specimens and with chest X-ray showing bilateral infiltrations or chest computerized tomographic (CT) images showing exudation or consolidation.
  • Requiring supplemental oxygen (nasal cannula, non-invasive CPAP, non-rebreathing face mask)
  • Capable of adopting a prone posture independently.

Who cannot join

  • The presence of any of the following will mean patients are ineligible:
  • life-threatening arrhythmias
  • Hemodynamic instability (defined as mean arterial pressure [MAP] < 65mm Hg and use of vasopressors to achieve MAP > 65 mm Hg)
  • Altered mental status, intracranial hypertension
  • Facial injuries
  • Spine or pelvic fractures
Show all 9Show fewer
  • Recent abdominal surgery
  • Pregnancy
  • Altered mental status and patients needing invasive ventilation.

Trial locations and contacts

1 site in 1 country.

Egypt1 site
  • Faculty of nursing

    Alexandria, 02225585888

Other trials in Egypt

About this study

Official title: Effects of Awake Prone Positioning on Oxygenation and Physiological Outcomes in Non-intubated COVID-19 Patients

The burden of coronavirus disease 2019 (COVID-19) pandemic is still on a rising course making a great stress on medical resources throughout the world. Although most of COVID-19 patients require non-invasive oxygenation and ventilation, rapid progression to hypoxemic respiratory failure and then acute respiratory distress syndrome (ARDS) can occur in some COVID19 patients due to prolonged or unaddressed hypoxia. Prone positioning is a common supportive ventilation strategy to improve oxygenation in critically ill patients with ARDS. Recent studies point out the potential benefits of using this strategy for non-intubated awake COVID 19 patients who are hypoxic. Despite several retrospective cohort studies have been conducted to identify impact of the prone positioning in awake non-intubated COVID-19 patients, experimental studies are very rare. This study therefore aims to evaluate the effects of self-prone positioning on oxygenation and physiological outcomes among awake-non intubated patients with COVID-19.

Read the detailed description

A randomised controlled trial design will be adopted to achieve the aim of the current study. In this study 82 adult patients of either sex with a confirmed diagnosis of COVID-19 will be recruited from general intensive care unit of the chest hospital (affiliated to the Ministry of Health) in Damanhour city, El Beheira Governorate, Egypt. Patients will be enrolled in the current study if they meet study inclusion criteria.

The eligible patients will be randomly assigned into two groups (control and intervention group) 41 patients in each. The control group will receive the standard management of COVID-19 patients according to the Egyptian Ministry of health guidelines. The standard management includes supplemental oxygen or non-invasive continuous positive airway pressure (CPAP), antivirals, antibiotics, anticoagulants and glucocorticoids, as necessary, based on the patients' clinical condition. Patients in the control group will be subjected to the conventional positioning interventions provided by the critical care nurses, which will not include self-prone positioning.

Patients in the intervention group will receive self-prone positioning and standard management of COVID-19 patients. All patients in both groups (control and intervention) will be monitored continuously by cardiac monitoring with oxygen saturation (SpO2) during the study period. The demographic and baseline clinical data of all eligible patients will collected and recorded using the study tool.

Each patient in the intervention group will be helped into the prone position and encouraged to stay in the prone position as long as tolerated (at least 1 hour). The prone positioning consists of placing the patient on his or her stomach with the head on the side. Self-prone position will be performed 45 minutes up to 1 hour after meals to avoid gastrointestinal side effects. The patient will be maintained in prone position until the patient becomes too tired and uncomfortable to keep that position. If patients will asked to regain the supine position before the 1 hour period was complete, patient's prone position will be considered unfeasible and the reason will be reported. Patients who required invasive mechanical ventilation at any time point will be intubated and excluded from the study.

The effect of patients' positioning on oxygenation and physiological parameters will be collected and recorded. These parameters include vital signs (respiratory rate, systolic blood pressure, diastolic blood pressure and heart rate), SpO2, oxygenation index (PaO2/FiO2 ratio), ROX index (combination of the ratio of oxygen saturation measured by pulse oximetry to fraction of inspired oxygen and respiratory rate [SpO2/FiO2]/respiratory rate) and arterial blood gases parameters (pH, PaO2mmHg, PaCO2mmHg and SaO2). These parameters will be recorded before and after positioning (immediately before, after 10 minutes and after 1hour). Data of secondary outcomes of self-prone positioning will also be collected and recorded.

Being tested
prone position group
Medical subject headings
COVID-19

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • prone position groupProcedure or surgery

    Patients randomized to this arm will receive self-prone positioning. Each patient in the intervention group will be helped into the prone position and encouraged to stay in the prone position as long as tolerated (at least 1 hour). The prone positioning consists of placing the patient on his or her stomach with the head on the side. Self-prone position will be performed 45 minutes up to 1 hour after meals to avoid gastrointestinal side effects. The patient will be maintained in prone position until the patient becomes too tired and uncomfortable to keep that position. If patients will asked to regain the supine position before the 1 hour period was complete, patient's prone position will be considered unfeasible and the reason will be reported. Patients who required invasive mechanical ventilation at any time point will be intubated and excluded from the study.

Study groups in NCT04760561
Study groupRoleWhat they receive
Control group (conventional care)No interventionPatients randomized to this arm will receive the conventional positioning interventions provided by the critical care nurses, which will not include self-prone positioning.
Intervention group (prone position group)ExperimentalPatients randomized to this arm will receive self-prone positioning.
Receives: Procedure: prone position group

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Oxygenation index

    arterial oxygen pressure/fractional inspired oxygen PaO2/FiO2 ratio mmHg.

    Measured: Change in the value immediately before, after 10 minutes and after 1hour of patient positioning

  2. SpO2

    Peripheral oxygen saturation

    Measured: Change in the value immediately before, after 10 minutes and after 1hour of patient positioning.

  3. ROX index

    combination of the ratio of oxygen saturation measured by pulse oximetry to fraction of inspired ox¬ygen and respiratory rate ([SpO2/FiO2]/respiratory rate)

    Measured: Change in the value immediately before and after 1hour of patient positioning.

  4. PaO2mmHg

    Partial pressure of oxygen within arterial blood

    Measured: change in the value immediately before and after 1hour of patient positioning.

  5. PCO2mmHg

    The partial pressure of carbon dioxide within arterial blood

    Measured: change in the value immediately before and after 1hour of patient positioning.

  6. SaO2

    Oxygen saturation (SaO2) is a measurement of the percentage of how much hemoglobin is saturated with oxygen.

    Measured: change in the value immediately before and after 1hour of patient positioning.

  7. pH

    The acidity or alkalinity of blood.

    Measured: change in the value immediately before and after 1hour of patient positioning.

  8. Respiratory Rate (RR) (bpm)

    the number of breaths a person takes per minute.

    Measured: change in the value immediately before, after 10 minutes and after 1hour of patient positioning.

  9. Heart Rate (HR) (bpm)

    is the the speed of the heartbeat measured by the number of contractions (beats) of the heart per minute (bpm)

    Measured: change in the value immediately before, after 10 minutes and after 1hour of patient positioning.

  10. Blood Pressure (BP) mmHg

    is the the pressure of circulating blood against the walls of blood vessels.

    Measured: change in the value immediately before, after 10 minutes and after 1hour of patient positioning.

  11. Positive response to prone positioning

    defined as a 10% increase in PaO2/FiO2 ratio or 10% decrease in respiratory rate

    Measured: Time Frame: change in the value of PaO2/FiO2 ratio or respiratory rate after 1hour of patient positioning

Secondary outcomes (1)
  1. Prone position adverse events

    respiratory distress, dyspnea, use of accessory respiratory muscles, oxygen desaturation SpO2≤70%, hypotension SBP≤90 mmHg, vomiting, aspiration, musculoskeletal pain, discomfort, facial edema, pressure ulcers and accidental withdrawal of catheters, tubes and/or drainages.

    Measured: appearance of events from 10 minutes after patient positioning up to 3hours after patient positioning..

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Feb 2021
  2. Study start20 Feb 2021
  3. Primary completion20 Mar 2021
  4. Study completion20 Apr 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Model description
Experimental research design
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
82 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04760561
Sponsor's protocol ID
Proning for COVID-19 Patients
Status last verified
Jan 2022
First submitted
15 Feb 2021
Last updated
4 Feb 2022
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Binda F, Marelli F, Galazzi A, Pascuzzo R, Adamini I, Laquintana D. Nursing Management of Prone Positioning in Patients With COVID-19. Crit Care Nurse. 2021 Apr 1;41(2):27-35. doi: 10.4037/ccn2020222.

    PubMed 33341885
  • Dubosh NM, Wong ML, Grossestreuer AV, Loo YK, Sanchez LD, Chiu D, Leventhal EL, Ilg A, Donnino MW. Early, awake proning in emergency department patients with COVID-19. Am J Emerg Med. 2021 Aug;46:640-645. doi: 10.1016/j.ajem.2020.11.074. Epub 2020 Dec 3.

    PubMed 33309507
  • Flynn Makic MB. Prone Position of Patients With COVID-19 and Acute Respiratory Distress Syndrome. J Perianesth Nurs. 2020 Aug;35(4):437-438. doi: 10.1016/j.jopan.2020.05.008. Epub 2020 May 30. No abstract available.

    PubMed 32741521
  • Solverson K, Weatherald J, Parhar KKS. Tolerability and safety of awake prone positioning COVID-19 patients with severe hypoxemic respiratory failure. Can J Anaesth. 2021 Jan;68(1):64-70. doi: 10.1007/s12630-020-01787-1. Epub 2020 Aug 14.

    PubMed 32803468
  • Sztajnbok J, Maselli-Schoueri JH, Cunha de Resende Brasil LM, Farias de Sousa L, Cordeiro CM, Sansao Borges LM, Malaque CMSA. Prone positioning to improve oxygenation and relieve respiratory symptoms in awake, spontaneously breathing non-intubated patients with COVID-19 pneumonia. Respir Med Case Rep. 2020;30:101096. doi: 10.1016/j.rmcr.2020.101096. Epub 2020 May 19.

    PubMed 32455107
  • Cotton S, Zawaydeh Q, LeBlanc S, Husain A, Malhotra A. Proning during covid-19: Challenges and solutions. Heart Lung. 2020 Nov-Dec;49(6):686-687. doi: 10.1016/j.hrtlng.2020.08.006. Epub 2020 Aug 19.

    PubMed 32861885

Questions about this trial

What is this clinical trial studying?

A study testing prone position group in people with Prone Position and Coronavirus Disease 2019, run by Damanhour University at 1 site in Egypt.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Feb 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Oxygenation index (time frame: Change in the value immediately before, after 10 minutes and after 1hour of patient positioning). The study lists 11 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04760561, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Feb 2022.

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