Associations of awake prone positioning-induced changes in physiology with intubation: An international prospective observational study in patients with acute hypoxemic respiratory failure related to COVID-19

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  • dc.contributor.author Morales Quinteros, Luis
  • dc.contributor.author Scala, Raffaele
  • dc.contributor.author Silva Jr, Joao M.
  • dc.contributor.author Leidi, Antonio
  • dc.contributor.author Leszek, Alexandre
  • dc.contributor.author Vazquez-Guillamet, Rodrigo
  • dc.contributor.author Pascual Guàrdia, Sergi, 1979-
  • dc.contributor.author Serpa-Neto, Ary
  • dc.contributor.author Artigas, Antoni
  • dc.contributor.author Schultz, Marcus J.
  • dc.date.accessioned 2024-11-06T07:17:08Z
  • dc.date.available 2024-11-06T07:17:08Z
  • dc.date.issued 2023
  • dc.description.abstract Introduction: Awake prone positioning has the potential to improve oxygenation and decrease respiratory rate, potentially reducing the need for intubation in patients with acute hypoxemic respiratory failure. We investigated awake prone positioning-induced changes in oxygenation and respiratory rate, and the prognostic capacity for intubation in patients with COVID-19 pneumonia. Methods: International multicenter prospective observation study in critically ill adult patients with COVID-19 receiving supplemental oxygen. We collected data on oxygenation and respiratory rate at baseline, and at 1 h after being placed in prone positioning. The combined primary outcome was oxygenation and respiratory rate at 1 h. The secondary endpoint was treatment failure, defined as need for intubation within 24 h of start of awake prone positioning. Results: Between March 27th and November 2020, 101 patients were enrolled of which 99 were fully analyzable. Awake prone positioning lasted mean of 3 [2-4] h. In 77 patients (77.7%), awake prone positioning improved oxygenation, and in 37 patients (54.4%) it decreased respiratory rate. Twenty-nine patients (29.3%) were intubated within 24 h. An increase in SpO2/FiO2 of < 10 (OR 5.1, 95% CI 1.4-18.5, P = 0.01), a failure to increase PaO2/FiO2 to > 116 mmHg (OR 3.6, 95% CI 1.2-10.8, P = 0.02), and a decrease in respiratory rate of < 2 breaths/min (OR 3.6, 95% CI 1.3-9.5, P = 0.01) were independent variables associated with need for intubation. The AUC-ROC curve for intubation using a multivariable model was 0.73 (95% CI 0.62-0.84). Conclusions: Awake prone positioning improves oxygenation in the majority of patients, and decreases respiratory rate in more than half of patients with acute hypoxemic respiratory failure caused by COVID-19. One in three patients need intubation within 24 h. Awake prone position-induced changes in oxygenation and respiratory rate have prognostic capacity for intubation within 24 h.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Morales-Quinteros L, Scala R, Silva JM Jr, Leidi A, Leszek A, Vazquez-Guillamet R, et al. Associations of awake prone positioning-induced changes in physiology with intubation: An international prospective observational study in patients with acute hypoxemic respiratory failure related to COVID-19. Pulm Ther. 2023 Dec;9(4):499-510. DOI: 10.1007/s41030-023-00242-y
  • dc.identifier.doi http://dx.doi.org/10.1007/s41030-023-00242-y
  • dc.identifier.issn 2364-1754
  • dc.identifier.uri http://hdl.handle.net/10230/68447
  • dc.language.iso eng
  • dc.publisher Springer
  • dc.relation.ispartof Pulm Ther. 2023 Dec;9(4):499-510
  • dc.rights © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial 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-nc/4.0/.
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
  • dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
  • dc.subject.keyword Acute hypoxemic respiratory failure
  • dc.subject.keyword Awake prone position
  • dc.subject.keyword COVID-19
  • dc.subject.keyword Coronavirus disease
  • dc.subject.keyword Intubation
  • dc.subject.keyword Prognostication
  • dc.subject.keyword Self-proning
  • dc.title Associations of awake prone positioning-induced changes in physiology with intubation: An international prospective observational study in patients with acute hypoxemic respiratory failure related to COVID-19
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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Articles (Hospital del Mar Research Institute)
Articles (Departament de Medicina i Ciències de la Vida)