학술논문
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
Document Type
article
Author
Mariano Esperatti; Marina Busico; Nora Angélica Fuentes; Adrian Gallardo; Javier Osatnik; Alejandra Vitali; Elizabeth Gisele Wasinger; Matías Olmos; Jorgelina Quintana; Santiago Nicolas Saavedra; Ana Inés Lagazio; Facundo Juan Andrada; Hiromi Kakisu; Nahuel Esteban Romano; Agustin Matarrese; Mariela Adriana Mogadouro; Giuliana Mast; Claudia Navarro Moreno; Greta Dennise Rebaza Niquin; Veronica Barbaresi; Alejandro Bruhn Cruz; Bruno Leonel Ferreyro; Antoni Torres; Argentine Collaborative Group on High Flow and Prone Positioning
Source
Critical Care, Vol 26, Iss 1, Pp 1-10 (2022)
Subject
Language
English
ISSN
1364-8535
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-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