Early versus late awake prone positioning in non-intubated patients with COVID-19
Abstract Background Awake prone positioning (APP) is widely used in the management of patients with coronavirus disease (COVID-19). The primary objective of this study was to compare the outcome of COVID-19 patients who received early versus late APP. Methods Post hoc analysis of data collected for...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-09-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-021-03761-9 |
| _version_ | 1818717292706398208 |
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| author | Ramandeep Kaur David L. Vines Sara Mirza Ahmad Elshafei Julie A. Jackson Lauren J. Harnois Tyler Weiss J. Brady Scott Matthew W. Trump Idrees Mogri Flor Cerda Amnah A. Alolaiwat Amanda R. Miller Andrew M. Klein Trevor W. Oetting Lindsey Morris Scott Heckart Lindsay Capouch Hangyong He Jie Li |
| author_facet | Ramandeep Kaur David L. Vines Sara Mirza Ahmad Elshafei Julie A. Jackson Lauren J. Harnois Tyler Weiss J. Brady Scott Matthew W. Trump Idrees Mogri Flor Cerda Amnah A. Alolaiwat Amanda R. Miller Andrew M. Klein Trevor W. Oetting Lindsey Morris Scott Heckart Lindsay Capouch Hangyong He Jie Li |
| author_sort | Ramandeep Kaur |
| collection | DOAJ |
| description | Abstract Background Awake prone positioning (APP) is widely used in the management of patients with coronavirus disease (COVID-19). The primary objective of this study was to compare the outcome of COVID-19 patients who received early versus late APP. Methods Post hoc analysis of data collected for a randomized controlled trial (ClinicalTrials.gov NCT04325906). Adult patients with acute hypoxemic respiratory failure secondary to COVID-19 who received APP for at least one hour were included. Early prone positioning was defined as APP initiated within 24 h of high-flow nasal cannula (HFNC) start. Primary outcomes were 28-day mortality and intubation rate. Results We included 125 patients (79 male) with a mean age of 62 years. Of them, 92 (73.6%) received early APP and 33 (26.4%) received late APP. Median time from HFNC initiation to APP was 2.25 (0.8–12.82) vs 36.35 (30.2–75.23) hours in the early and late APP group (p < 0.0001), respectively. Average APP duration was 5.07 (2.0–9.05) and 3.0 (1.09–5.64) hours per day in early and late APP group (p < 0.0001), respectively. The early APP group had lower mortality compared to the late APP group (26% vs 45%, p = 0.039), but no difference was found in intubation rate. Advanced age (OR 1.12 [95% CI 1.0–1.95], p = 0.001), intubation (OR 10.65 [95% CI 2.77–40.91], p = 0.001), longer time to initiate APP (OR 1.02 [95% CI 1.0–1.04], p = 0.047) and hydrocortisone use (OR 6.2 [95% CI 1.23–31.1], p = 0.027) were associated with increased mortality. Conclusions Early initiation (< 24 h of HFNC use) of APP in acute hypoxemic respiratory failure secondary to COVID-19 improves 28-day survival. Trial registration ClinicalTrials.gov NCT04325906. |
| first_indexed | 2024-12-17T19:32:50Z |
| format | Article |
| id | doaj.art-9ff92ba6079942b9a164a30d70cdf975 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-17T19:32:50Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-9ff92ba6079942b9a164a30d70cdf9752022-12-21T21:35:12ZengBMCCritical Care1364-85352021-09-012511910.1186/s13054-021-03761-9Early versus late awake prone positioning in non-intubated patients with COVID-19Ramandeep Kaur0David L. Vines1Sara Mirza2Ahmad Elshafei3Julie A. Jackson4Lauren J. Harnois5Tyler Weiss6J. Brady Scott7Matthew W. Trump8Idrees Mogri9Flor Cerda10Amnah A. Alolaiwat11Amanda R. Miller12Andrew M. Klein13Trevor W. Oetting14Lindsey Morris15Scott Heckart16Lindsay Capouch17Hangyong He18Jie Li19Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical CenterDivision of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical CenterDivision of Pulmonary, Critical Care, and Sleep Medicine, Rush University Medical CenterDivision of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical CenterDepartment of Respiratory Care, Unity Point Health-Des MoinesDivision of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical CenterDivision of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical CenterDivision of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical CenterThe Iowa Clinic P.C. and Unity Point Health-Des MoinesPulmonary and Critical Care Medicine Division, Texas A&M School of Medicine, Baylor University Medical CenterNursing, MICU, Rush University Medical CenterDivision of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical CenterDivision of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical CenterDivision of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical CenterDepartment of Respiratory Care, Unity Point Health-Des MoinesPulmonary and Critical Care Medicine Division, Texas A&M School of Medicine, Baylor University Medical CenterDepartment of Respiratory Care, Unity Point Health-Des MoinesDepartment of Respiratory Care, Unity Point Health-Des MoinesDepartment of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical UniversityDivision of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical CenterAbstract Background Awake prone positioning (APP) is widely used in the management of patients with coronavirus disease (COVID-19). The primary objective of this study was to compare the outcome of COVID-19 patients who received early versus late APP. Methods Post hoc analysis of data collected for a randomized controlled trial (ClinicalTrials.gov NCT04325906). Adult patients with acute hypoxemic respiratory failure secondary to COVID-19 who received APP for at least one hour were included. Early prone positioning was defined as APP initiated within 24 h of high-flow nasal cannula (HFNC) start. Primary outcomes were 28-day mortality and intubation rate. Results We included 125 patients (79 male) with a mean age of 62 years. Of them, 92 (73.6%) received early APP and 33 (26.4%) received late APP. Median time from HFNC initiation to APP was 2.25 (0.8–12.82) vs 36.35 (30.2–75.23) hours in the early and late APP group (p < 0.0001), respectively. Average APP duration was 5.07 (2.0–9.05) and 3.0 (1.09–5.64) hours per day in early and late APP group (p < 0.0001), respectively. The early APP group had lower mortality compared to the late APP group (26% vs 45%, p = 0.039), but no difference was found in intubation rate. Advanced age (OR 1.12 [95% CI 1.0–1.95], p = 0.001), intubation (OR 10.65 [95% CI 2.77–40.91], p = 0.001), longer time to initiate APP (OR 1.02 [95% CI 1.0–1.04], p = 0.047) and hydrocortisone use (OR 6.2 [95% CI 1.23–31.1], p = 0.027) were associated with increased mortality. Conclusions Early initiation (< 24 h of HFNC use) of APP in acute hypoxemic respiratory failure secondary to COVID-19 improves 28-day survival. Trial registration ClinicalTrials.gov NCT04325906.https://doi.org/10.1186/s13054-021-03761-9Awake prone positioningNon-intubatedCOVID-19CoronavirusAcute hypoxemic respiratory failure |
| spellingShingle | Ramandeep Kaur David L. Vines Sara Mirza Ahmad Elshafei Julie A. Jackson Lauren J. Harnois Tyler Weiss J. Brady Scott Matthew W. Trump Idrees Mogri Flor Cerda Amnah A. Alolaiwat Amanda R. Miller Andrew M. Klein Trevor W. Oetting Lindsey Morris Scott Heckart Lindsay Capouch Hangyong He Jie Li Early versus late awake prone positioning in non-intubated patients with COVID-19 Critical Care Awake prone positioning Non-intubated COVID-19 Coronavirus Acute hypoxemic respiratory failure |
| title | Early versus late awake prone positioning in non-intubated patients with COVID-19 |
| title_full | Early versus late awake prone positioning in non-intubated patients with COVID-19 |
| title_fullStr | Early versus late awake prone positioning in non-intubated patients with COVID-19 |
| title_full_unstemmed | Early versus late awake prone positioning in non-intubated patients with COVID-19 |
| title_short | Early versus late awake prone positioning in non-intubated patients with COVID-19 |
| title_sort | early versus late awake prone positioning in non intubated patients with covid 19 |
| topic | Awake prone positioning Non-intubated COVID-19 Coronavirus Acute hypoxemic respiratory failure |
| url | https://doi.org/10.1186/s13054-021-03761-9 |
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