Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study

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• dc.contributor.author Ferrando, Carlos
• dc.contributor.author Mellado Artigas, Ricard
• dc.contributor.author Gea, Alfredo
• dc.contributor.author Arruti, Egoitz
• dc.contributor.author Aldecoa, César
• dc.contributor.author Adalia Bartolomé, Ramón
• dc.contributor.author Ramasco Rueda, Fernando
• dc.contributor.author Monedero, Pablo
• dc.contributor.author Maseda, Emilio
• dc.contributor.author Tamayo, Gonzalo
• dc.contributor.author Hernández Sanz, María L.
• dc.contributor.author Mercadal, Jordi
• dc.contributor.author Martín Grande, Ascensión
• dc.contributor.author Kacmarek, Robert M.
• dc.contributor.author Villar, Jesús
• dc.contributor.author Suárez Sipmann, Fernando
• dc.contributor.author COVID-19 Spanish ICU Network
• dc.date.accessioned 2021-09-09T06:58:23Z
• dc.date.available 2021-09-09T06:58:23Z
• dc.date.issued 2020
• dc.description.abstract Background: Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone. Methods: Prospective, multicenter, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory Sequential Organ Failure Assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate, and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP. Results: A total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO + awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95% CI 0.53-1.43), p = 0.60]. Patients treated with HFNO + awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0-2.5) vs 2 IQR 1.0-3.0] days (p = 0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95% CI 0.40-2.72), p = 0.92]. Conclusion: In patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality.
• dc.format.mimetype application/pdf
• dc.identifier.citation Ferrando C, Mellado-Artigas R, Gea A, Arruti E, Aldecoa C, Adalia R, et al. Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study. Crit Care. 2020;24(1):597. DOI: 10.1186/s13054-020-03314-6
• dc.identifier.doi http://dx.doi.org/10.1186/s13054-020-03314-6
• dc.identifier.issn 1364-8535
• dc.identifier.uri http://hdl.handle.net/10230/48418
• dc.language.iso eng
• dc.publisher BioMed Central
• dc.relation.ispartof Crit Care. 2020;24(1):597
• dc.rights © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Acute respiratory failure
• dc.subject.keyword COVID-19
• dc.subject.keyword Critical care
• dc.subject.keyword High-flow nasal oxygen therapy
• dc.subject.keyword Mechanical ventilation
• dc.subject.keyword Prone positioning
• dc.title Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion