Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy
Background: Patients with COVID-19 may experience hypoxemic Acute Respiratory Failure (hARF) requiring O<sub>2</sub>-therapy by High-Flow Nasal Cannula (HFNO). Although Prone Positioning (PP) may improve oxygenation in COVID-19 non-intubated patients, the results on its clinical efficacy...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/15/3404 |
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| author | Andrea Vianello Martina Turrin Gabriella Guarnieri Beatrice Molena Giovanna Arcaro Cristian Turato Fausto Braccioni Leonardo Bertagna De Marchi Federico Lionello Pavle Subotic Stefano Masiero Chiara Giraudo Paolo Navalesi |
| author_facet | Andrea Vianello Martina Turrin Gabriella Guarnieri Beatrice Molena Giovanna Arcaro Cristian Turato Fausto Braccioni Leonardo Bertagna De Marchi Federico Lionello Pavle Subotic Stefano Masiero Chiara Giraudo Paolo Navalesi |
| author_sort | Andrea Vianello |
| collection | DOAJ |
| description | Background: Patients with COVID-19 may experience hypoxemic Acute Respiratory Failure (hARF) requiring O<sub>2</sub>-therapy by High-Flow Nasal Cannula (HFNO). Although Prone Positioning (PP) may improve oxygenation in COVID-19 non-intubated patients, the results on its clinical efficacy are controversial. The present study aims to prospectively investigate whether PP may reduce the need for endotracheal intubation (ETI) in patients with COVID-19 receiving HFNO. Methods: All consecutive unselected adult patients with bilateral lung opacities on chest X-ray receiving HFNO after admission to a SARS-CoV-2 Respiratory Intermediate Care Unit (RICU) were considered eligible. Patients who successfully passed an initial PP trial (success group) underwent PP for periods ≥ 2 h twice a day, while receiving HFNO. The study’s primary endpoint was the intubation rate during the stay in the RICU. Results: Ninety-three patients were included in the study. PP was feasible and safe in 50 (54%) patients. Sixteen (17.2%) patients received ETI and 27 (29%) escalated respiratory support, resulting in a mortality rate of 9/93 (9.7%). The length of hospital stay was 18 (6–75) days. In 41/50 (80%) of subjects who passed the trial and underwent PP, its use was associated with clinical benefit and survival without escalation of therapy. Conclusions: PP is feasible and safe in over 50% of COVID-19 patients receiving HFNO for hARF. Randomized trials are required to confirm that PP has the potential to reduce intubation rate. |
| first_indexed | 2024-03-10T09:13:08Z |
| format | Article |
| id | doaj.art-947b465feb5145dd8fe76334b66f73c2 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T09:13:08Z |
| publishDate | 2021-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-947b465feb5145dd8fe76334b66f73c22023-11-22T05:50:17ZengMDPI AGJournal of Clinical Medicine2077-03832021-07-011015340410.3390/jcm10153404Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen TherapyAndrea Vianello0Martina Turrin1Gabriella Guarnieri2Beatrice Molena3Giovanna Arcaro4Cristian Turato5Fausto Braccioni6Leonardo Bertagna De Marchi7Federico Lionello8Pavle Subotic9Stefano Masiero10Chiara Giraudo11Paolo Navalesi12Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, ItalyDepartment of Molecular Medicine, University of Pavia, 27100 Pavia, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, ItalyDepartment of Neurosciences, University of Padova, 35128 Padova, ItalyDepartment of Medicine DIMED, University of Padova, 35128 Padova, ItalyDepartment of Medicine DIMED, University of Padova, 35128 Padova, ItalyBackground: Patients with COVID-19 may experience hypoxemic Acute Respiratory Failure (hARF) requiring O<sub>2</sub>-therapy by High-Flow Nasal Cannula (HFNO). Although Prone Positioning (PP) may improve oxygenation in COVID-19 non-intubated patients, the results on its clinical efficacy are controversial. The present study aims to prospectively investigate whether PP may reduce the need for endotracheal intubation (ETI) in patients with COVID-19 receiving HFNO. Methods: All consecutive unselected adult patients with bilateral lung opacities on chest X-ray receiving HFNO after admission to a SARS-CoV-2 Respiratory Intermediate Care Unit (RICU) were considered eligible. Patients who successfully passed an initial PP trial (success group) underwent PP for periods ≥ 2 h twice a day, while receiving HFNO. The study’s primary endpoint was the intubation rate during the stay in the RICU. Results: Ninety-three patients were included in the study. PP was feasible and safe in 50 (54%) patients. Sixteen (17.2%) patients received ETI and 27 (29%) escalated respiratory support, resulting in a mortality rate of 9/93 (9.7%). The length of hospital stay was 18 (6–75) days. In 41/50 (80%) of subjects who passed the trial and underwent PP, its use was associated with clinical benefit and survival without escalation of therapy. Conclusions: PP is feasible and safe in over 50% of COVID-19 patients receiving HFNO for hARF. Randomized trials are required to confirm that PP has the potential to reduce intubation rate.https://www.mdpi.com/2077-0383/10/15/3404COVID-19prone positioningacute respiratory failureendotracheal intubation |
| spellingShingle | Andrea Vianello Martina Turrin Gabriella Guarnieri Beatrice Molena Giovanna Arcaro Cristian Turato Fausto Braccioni Leonardo Bertagna De Marchi Federico Lionello Pavle Subotic Stefano Masiero Chiara Giraudo Paolo Navalesi Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy Journal of Clinical Medicine COVID-19 prone positioning acute respiratory failure endotracheal intubation |
| title | Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy |
| title_full | Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy |
| title_fullStr | Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy |
| title_full_unstemmed | Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy |
| title_short | Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy |
| title_sort | prone positioning is safe and may reduce the rate of intubation in selected covid 19 patients receiving high flow nasal oxygen therapy |
| topic | COVID-19 prone positioning acute respiratory failure endotracheal intubation |
| url | https://www.mdpi.com/2077-0383/10/15/3404 |
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