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

Media type: E-Article
Title: 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
Contributor: Esperatti, Mariano; Busico, Marina; Fuentes, Nora Angélica; Gallardo, Adrian; Osatnik, Javier; Vitali, Alejandra; Wasinger, Elizabeth Gisele; Olmos, Matías; Quintana, Jorgelina; Saavedra, Santiago Nicolas; Lagazio, Ana Inés; Andrada, Facundo Juan; Kakisu, Hiromi; Romano, Nahuel Esteban; Matarrese, Agustin; Mogadouro, Mariela Adriana; Mast, Giuliana; Moreno, Claudia Navarro; Niquin, Greta Dennise Rebaza; Barbaresi, Veronica; Bruhn Cruz, Alejandro; Ferreyro, Bruno Leonel; Torres, Antoni; Tirado, Anabel Miranda; [...]
imprint: Springer Science and Business Media LLC, 2022
Published in: Critical Care
Language: English
DOI: 10.1186/s13054-021-03881-2
ISSN: 1364-8535
Origination:
Footnote:
Description: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>In 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.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>This 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.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>During 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)].</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>In 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.</jats:p> </jats:sec>
Access State: Open Access

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