dc.contributor
Institut Català de la Salut
dc.contributor
[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
dc.contributor
Vall d'Hebron Barcelona Hospital Campus
dc.contributor.author
Ibarra-Estrada, Miguel
dc.contributor.author
Li, Jie
dc.contributor.author
Pavlov, Ivan
dc.contributor.author
Perez, Yonatan
dc.contributor.author
Roca Gas, Oriol
dc.contributor.author
Tavernier, Elsa
dc.date.accessioned
2025-10-24T10:33:32Z
dc.date.available
2025-10-24T10:33:32Z
dc.date.issued
2022-08-12T09:52:46Z
dc.date.issued
2022-08-12T09:52:46Z
dc.date.issued
2022-03-28
dc.identifier
Ibarra-Estrada M, Li J, Pavlov I, Perez Y, Roca O, Tavernier E, et al. Factors for success of awake prone positioning in patients with COVID-19-induced acute hypoxemic respiratory failure: analysis of a randomized controlled trial. Crit Care. 2022 Mar 28;26:84.
dc.identifier
https://hdl.handle.net/11351/8000
dc.identifier
10.1186/s13054-022-03950-0
dc.identifier
000778606300001
dc.identifier.uri
https://hdl.handle.net/11351/8000
dc.description.abstract
Acute hypoxemic respiratory failure; COVID-19; Intubation
dc.description.abstract
Insuficiencia respiratoria hipoxémica aguda; COVID-19; Intubación
dc.description.abstract
Insuficiència respiratòria hipoxèmica aguda; COVID-19; Intubació
dc.description.abstract
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.
dc.format
application/pdf
dc.relation
Critical Care;26
dc.relation
https://doi.org/10.1186/s13054-022-03950-0
dc.rights
Attribution 4.0 International
dc.rights
http://creativecommons.org/licenses/by/4.0/
dc.rights
info:eu-repo/semantics/openAccess
dc.subject
Insuficiència respiratòria - Tractament
dc.subject
COVID-19 (Malaltia) - Complicacions
dc.subject
DISEASES::Respiratory Tract Diseases::Respiration Disorders::Respiratory Insufficiency
dc.subject
Other subheadings::Other subheadings::/therapy
dc.subject
DISEASES::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections
dc.subject
Other subheadings::Other subheadings::Other subheadings::/complications
dc.subject
ENFERMEDADES::enfermedades respiratorias::trastornos respiratorios::insuficiencia respiratoria
dc.subject
Otros calificadores::Otros calificadores::/terapia
dc.subject
ENFERMEDADES::virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus
dc.subject
Otros calificadores::Otros calificadores::Otros calificadores::/complicaciones
dc.title
Factors for success of awake prone positioning in patients with COVID-19-induced acute hypoxemic respiratory failure: analysis of a randomized controlled trial
dc.type
info:eu-repo/semantics/article
dc.type
info:eu-repo/semantics/publishedVersion
