Impact of exposure time in awake prone positioning on clinical outcomes of patients with COVID-19-related acute respiratory failure treated with high-flow nasal oxygen: a multicenter cohort study

Critical Care

Alejandro Bruhn Cruz¹  Nahuel Esteban Romano²  Jorgelina Quintana²  Marina Busico³  Santiago Nicolas Saavedra⁴  Greta Dennise Rebaza Niquin⁴  Agustin Matarrese⁴  Javier Osatnik⁵  Matías Olmos⁶  Hiromi Kakisu⁶  Claudia Navarro Moreno⁶  Veronica Barbaresi⁶  Mariano Esperatti⁷  Nora Angélica Fuentes⁷  Elizabeth Gisele Wasinger⁸  Giuliana Mast⁸  Facundo Juan Andrada⁸  Adrian Gallardo⁹  Mariela Adriana Mogadouro^1,10  Alejandra Vitali^1,10  Ana Inés Lagazio^1,10  Bruno Leonel Ferreyro^1,11  Antoni Torres^1,12 

[1] Departement of Intensive Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile;Intensive Care Unit, Clínica Olivos SMG, Av. Maipú 1660, B1602 ABQ, Olivos, Provincia de Buenos Aires, Argentina;Intensive Care Unit, Clínica Olivos SMG, Av. Maipú 1660, B1602 ABQ, Olivos, Provincia de Buenos Aires, Argentina;Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina;Intensive Care Unit, Hospital Aleman, Ciudad Autónoma de Buenos Aires, Argentina;Intensive Care Unit, Hospital Aleman, Ciudad Autónoma de Buenos Aires, Argentina;Universidad del Salvador, Buenos Aires, Argentina;Intensive Care Unit, Hospital Privado de Comunidad, Mar del Plata, Argentina;Intensive Care Unit, Hospital Privado de Comunidad, Mar del Plata, Argentina;Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina;Intensive Care Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina;Universidad Austral, Pilar, Buenos Aires, Argentina;Intensive Care Unit, Sanatorio Clínica Modelo de Morón, Morón, Buenos Aires, Argentina;Universidad de Morón, Morón, Buenos Aires, Argentina;Intensive Care Unit, Sanatorio de La Trinidad Palermo, Ciudad Autónoma de Buenos Aires, Argentina;Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada;Pulmonary Department, Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Spain;

关键词: Acute respiratory failure;    Awake;    COVID-19;    Endotracheal intubation;    Mortality;    Prone position;   

DOI  :  10.1186/s13054-021-03881-2

来源: Springer

【 摘 要 】

BackgroundIn patients with COVID-19-related acute respiratory failure (ARF), awake prone positioning (AW-PP) reduces the need for intubation in patients treated with high-flow nasal oxygen (HFNO). However, the effects of different exposure times on clinical outcomes remain unclear. We evaluated the effect of AW-PP on the risk of endotracheal intubation and in-hospital mortality in patients with COVID-19-related ARF treated with HFNO and analyzed the effects of different exposure times to AW-PP.MethodsThis multicenter prospective cohort study in six ICUs of 6 centers in Argentine consecutively included patients > 18 years of age with confirmed COVID-19-related ARF requiring HFNO from June 2020 to January 2021. In the primary analysis, the main exposure was awake prone positioning for at least 6 h/day, compared to non-prone positioning (NON-PP). In the sensitivity analysis, exposure was based on the number of hours receiving AW-PP. Inverse probability weighting–propensity score (IPW-PS) was used to adjust the conditional probability of treatment assignment. The primary outcome was endotracheal intubation (ETI); and the secondary outcome was hospital mortality.ResultsDuring the study period, 580 patients were screened and 335 were included; 187 (56%) tolerated AW-PP for [median (p25–75)] 12 (9–16) h/day and 148 (44%) served as controls. The IPW–propensity analysis showed standardized differences < 0.1 in all the variables assessed. After adjusting for other confounders, the OR (95% CI) for ETI in the AW-PP group was 0.36 (0.2–0.7), with a progressive reduction in OR as the exposure to AW-PP increased. The adjusted OR (95% CI) for hospital mortality in the AW-PP group ≥ 6 h/day was 0.47 (0.19–1.31). The exposure to prone positioning ≥ 8 h/d resulted in a further reduction in OR [0.37 (0.17–0.8)].ConclusionIn the study population, AW-PP for ≥ 6 h/day reduced the risk of endotracheal intubation, and exposure ≥ 8 h/d reduced the risk of hospital mortality.

【 授权许可】

CC BY