Abstract
BackgroundAwake prone positioning (APP) is widely used in the management of patients with coronavirus disease (COVID-19). The primary objective of this study was to compare the outcome of COVID-19 patients who received early versus late APP.MethodsPost hoc analysis of data collected for a randomized controlled trial (ClinicalTrials.gov NCT04325906). Adult patients with acute hypoxemic respiratory failure secondary to COVID-19 who received APP for at least one hour were included. Early prone positioning was defined as APP initiated within 24 h of high-flow nasal cannula (HFNC) start. Primary outcomes were 28-day mortality and intubation rate.ResultsWe included 125 patients (79 male) with a mean age of 62 years. Of them, 92 (73.6%) received early APP and 33 (26.4%) received late APP. Median time from HFNC initiation to APP was 2.25 (0.8–12.82) vs 36.35 (30.2–75.23) hours in the early and late APP group (p < 0.0001), respectively. Average APP duration was 5.07 (2.0–9.05) and 3.0 (1.09–5.64) hours per day in early and late APP group (p < 0.0001), respectively. The early APP group had lower mortality compared to the late APP group (26% vs 45%, p = 0.039), but no difference was found in intubation rate. Advanced age (OR 1.12 [95% CI 1.0–1.95], p = 0.001), intubation (OR 10.65 [95% CI 2.77–40.91], p = 0.001), longer time to initiate APP (OR 1.02 [95% CI 1.0–1.04], p = 0.047) and hydrocortisone use (OR 6.2 [95% CI 1.23–31.1], p = 0.027) were associated with increased mortality.ConclusionsEarly initiation (< 24 h of HFNC use) of APP in acute hypoxemic respiratory failure secondary to COVID-19 improves 28-day survival.Trial registration ClinicalTrials.gov NCT04325906.
Highlights
Coronavirus disease (COVID-19) is a viral infectious disease caused by coronavirus (SARS-CoV-2) [1]
Before the COVID-19 pandemic, a small, prospective observational study demonstrated the benefit of using prone positioning among non-intubated patients with moderate acute respiratory distress syndrome (ARDS) to reduce the need for invasive mechanical ventilation [4]
From April 2nd, 2020 to January 26th, 2021, we participated in a collaborative meta-trial of six randomized controlled open-label superiority trials [17] to compare the effectiveness of Awake prone positioning (APP) versus standard care in patients with acute hypoxemic respiratory failure (AHRF) due to COVID-19 supported with high-flow nasal cannula (HFNC)
Summary
Coronavirus disease (COVID-19) is a viral infectious disease caused by coronavirus (SARS-CoV-2) [1]. Around 25–30% of COVID19 patients develop signs of acute respiratory distress requiring higher respiratory support in terms of oxygen therapy, noninvasive and invasive positive pressure ventilation [2]. Before the COVID-19 pandemic, a small, prospective observational study demonstrated the benefit of using prone positioning among non-intubated patients with moderate acute respiratory distress syndrome (ARDS) to reduce the need for invasive mechanical ventilation [4]. Since the emergence of COVID-19, this technique has been extensively used to improve oxygenation in non-intubated COVID-19 patients with acute hypoxemic respiratory failure (AHRF) [5]. Awake prone positioning (APP) is widely used in the management of patients with coronavirus disease (COVID-19). The primary objective of this study was to compare the outcome of COVID-19 patients who received early versus late APP
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