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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
Author: 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
Esteban Romano, Nahuel
Matarrese, Agustin
Mogadouro, Mariela Adriana
Mast, Giuliana
Navarro Moreno, Claudia
Rebaza Niquin, Greta Dennise
Barbaresi, Veronica
Bruhn Cruz, Alejandro
Ferreyro, Bruno Leonel
Torres Martí, Antoni
Argentine Collaborative Group on High Flow and Pro
Keywords: COVID-19
Insuficiència respiratòria
Posicions dels malalts
Respiratory insufficiency
Positioning of patients
Oxygen therapy
Issue Date: 7-Jan-2022
Publisher: BioMed Central
Abstract: 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-fow nasal oxygen (HFNO). However, the efects of different exposure times on clinical outcomes remain unclear. We evaluated the efect 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 efects of diferent 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 confrmed 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 diferences<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
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It is part of: Critical Care, 2022, vol. 26, num. 1, p. 16-25
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ISSN: 1364-8535
Appears in Collections:Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Medicina)

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