Sistema de Salut de Catalunya
Institut Català de la Salut
[Ibarra-Estrada M] Unidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde, Jalisco, Mexico. [Li J] Department of Cardio pulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA. [Pavlov I] Department of Emergency Medicine, Hôpital de Verdun, Montréal, Québec, Canada. [Perez Y] CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSep FCRIN Research Network, Tours, France. [Roca O] Unitat de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. [Tavernier E] Clinical Investigation Center, INSERM 1415, CHRU Tours, Tours, France. Methods in Patients Centered Outcomes and Health Research, INSERM, UMR 1246, Nantes, France
Vall d'Hebron Barcelona Hospital Campus
2022-08-12T09:52:46Z
2022-08-12T09:52:46Z
2022-03-28
Acute hypoxemic respiratory failure; COVID-19; Intubation
Insuficiencia respiratoria hipoxémica aguda; COVID-19; Intubación
Insuficiència respiratòria hipoxèmica aguda; COVID-19; Intubació
Background Awake prone positioning (APP) improves oxygenation in coronavirus disease (COVID-19) patients and, when successful, may decrease the risk of intubation. However, factors associated with APP success remain unknown. In this secondary analysis, we aimed to assess whether APP can reduce intubation rate in patients with COVID-19 and to focus on the factors associated with success. Methods In this multicenter randomized controlled trial, conducted in three high-acuity units, we randomly assigned patients with COVID-19-induced acute hypoxemic respiratory failure (AHRF) requiring high-flow nasal cannula (HFNC) oxygen to APP or standard care. Primary outcome was intubation rate at 28 days. Multivariate analyses were performed to identify the predictors associated to treatment success (survival without intubation). Results Among 430 patients randomized, 216 were assigned to APP and 214 to standard care. The APP group had a lower intubation rate (30% vs 43%, relative risk [RR] 0.70; CI95 0.54–0.90, P = 0.006) and shorter hospital length of stay (11 interquartile range [IQR, 9–14] vs 13 [IQR, 10–17] days, P = 0.001). A respiratory rate ≤ 25 bpm at enrollment, an increase in ROX index > 1.25 after first APP session, APP duration > 8 h/day, and a decrease in lung ultrasound score ≥ 2 within the first 3 days were significantly associated with treatment success for APP. Conclusion In patients with COVID-19-induced AHRF treated by HFNC, APP reduced intubation rate and improved treatment success. A longer APP duration is associated with APP success, while the increase in ROX index and decrease in lung ultrasound score after APP can also help identify patients most likely to benefit.
Article
Published version
English
Insuficiència respiratòria - Tractament; COVID-19 (Malaltia) - Complicacions; DISEASES::Respiratory Tract Diseases::Respiration Disorders::Respiratory Insufficiency; Other subheadings::Other subheadings::/therapy; DISEASES::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections; Other subheadings::Other subheadings::Other subheadings::/complications; ENFERMEDADES::enfermedades respiratorias::trastornos respiratorios::insuficiencia respiratoria; Otros calificadores::Otros calificadores::/terapia; ENFERMEDADES::virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus; Otros calificadores::Otros calificadores::Otros calificadores::/complicaciones
BMC
Critical Care;26
https://doi.org/10.1186/s13054-022-03950-0
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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