Use of mechanical insufflation exsufflation and manual techniques in an intubated adult with COVID-19 positioned in prone-A case study

Background and purpose: The therapeutic benefits of prone positioning have been described over the last 50 years culminating in a systematic review supporting this management strategy for patients with severe hypoxaemic respiratory failure. Early work detailing treatment approaches for COVID-19 have advocated the use of prone positioning. Limited data exists regarding physiotherapy intervention in patients with COVID-19 owing to the recent emergence of this novel disease. Despite the acknowledged beneficial effects of physiotherapy on secretion clearance and lung recruitment in the general critical care population, there is a lack of evidence pertaining to physiotherapeutic intervention for acutely unwell intubated adults in prone lying.

Methods: This case study report follows the CARE case report guidelines. One patient with COVID-19 pneumonitis who underwent physiotherapy intervention in prone lying is discussed. Informed consent was gained from next of kin for data to be published.

Results: Treatment techniques including mechanical insufflation-exsufflation in prone were feasible and well tolerated by this patient with only transient adverse effects noted. Treatment techniques assisted with secretion clearance.

Discussion: Further work on safety, feasibility, and efficacy of physiotherapy intervention in patients with and without COVID-19 in prone will contribute to the evidence base on this subject.