Esperatti, MarianoBusico, MarinaFuentes, Nora AngélicaGallardo, AdrianOsatnik, JavierVitali, AlejandraWasinger, Elizabeth GiseleOlmos, MatíasQuintana, JorgelinaSaavedra, Santiago NicolasLagazio, Ana InésAndrada, Facundo JuanKakisu, HiromiEsteban Romano, NahuelMatarrese, AgustinMogadouro, Mariela AdrianaMast, GiulianaNavarro Moreno, ClaudiaRebaza Niquin, Greta DenniseBarbaresi, VeronicaBruhn Cruz, AlejandroFerreyro, Bruno LeonelTorres Martí, AntoniArgentine Collaborative Group on High Flow and Pro2022-05-242022-05-242022-01-071364-8535https://hdl.handle.net/2445/185982Abstract 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 adjusted10 p.application/pdfengcc-by (c) Esperatti, Mariano et al., 2022https://creativecommons.org/licenses/by/4.0/COVID-19Insuficiència respiratòriaIntubacióPosicions dels malaltsOxigenoteràpiaMortalitatCOVID-19Respiratory insufficiencyIntubationPositioning of patientsOxygen therapyMortalityinfo:eu-repo/semantics/article7220472022-05-24info:eu-repo/semantics/openAccess34996496