COVID-19 Severity Correlates with Weaker T-Cell Immunity, Hypercytokinemia, and Lung Epithelium Injury
Zhongfang Wang, Xiaoyun Yang, Yumin Zhou, Jing Sun, Xiaoqing Liu, Jing Zhang, Xinyue Mei, Jiaying Zhong, Jincun Zhao, Pixin Ran
Abstract
There are several limitations in the data from this case series.First, as is common with case series, selection bias is possible.Second, there was no control intervention, and the study sample was small.Third, it is uncertain whether these patients would have improved without prone positioning, although the rapid change, within 1 hour, after proning is suggestive of a favorable impact.Fourth, measures of patient dyspnea or comfort after prone positioning were not collected.Fifth, to minimize the documentation burden on nursing-staff workflow, data on patient adherence to the prone-positioning recommendation beyond the first episode of proning were not collected.Given the potential of prone positioning as a low-cost, easily implemented, and scalable intervention, particularly in low-and middle-income countries, expeditious yet thorough testing of prone positioning in patients at risk for intubation is warranted (e.g., W. Al-Hazzani and colleagues, unpublished results