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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 ; [...]

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

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  • Medientyp: E-Artikel
  • Titel: 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
  • Beteiligte: 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 ; Viñas, María Constanza ; Pintos, Juan Manuel ; Gonzalez, Maria Eugenia ; Mateos, Maite ; Laiz, Mariela Marisol ; Garcia Urrutia, Jose ; Ruiz Seifert, Micaela ; Mastroberti, Emilce
  • Erschienen: Springer Science and Business Media LLC, 2022
  • Erschienen in: Critical Care, 26 (2022) 1
  • Sprache: Englisch
  • DOI: 10.1186/s13054-021-03881-2
  • ISSN: 1364-8535
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: Abstract Background 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. Methods 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. Results 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)]. Conclusion 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.
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