BACKGROUND: Awake prone positioning has been widely used in patients with COVID-19 respiratory failure to avoid intubation despite limited evidence. Our objective was to evaluate if prone positioning is associated with a reduced intubation rate when compared to usual care. METHODS: This was a retrospective cohort study in the emergency department of a large quaternary hospital in Sao Paulo. We retrieved data from all admitted patients in need of oxygen supplementation (>3 L/min) and tachypnea (>24 ipm) from March 1 to April 30, 2020, excluding those who had any contraindication to the prone position or who had an immediate need for intubation. The primary endpoint was endotracheal intubation up to 15 days. Secondary outcomes included a 6-point clinical outcome ordinal scale, mechanical ventilation-free days, admission to the intensive care unit, and need of hemodialysis and of vasoactive drugs, all assessed at or up to 15 days. We analyzed unadjusted and adjusted effect estimates with Cox proportional hazards models, logistic regression, quantile regression, and sensitivity analyses using propensity score models. RESULTS: Of 925 suspected COVID-19 patients admitted off mechanical ventilation, 166 patients fulfilled inclusion and exclusion criteria: 57 were exposed to prone positioning and 109 to usual care. In the intervention group, 33 (58%) were intubated versus 53 (49%) in the control group. We observed no difference in intubation rates in the univariate analysis (hazard ratio = 1.21, 95% confidence interval [CI] = 0.78 to 1.88, p = 0.39) nor in the adjusted analysis (hazard ratio = 0.90, 95% CI = 0.55 to 1.49, p = 0.69). Results were robust to the sensitivity analyses. Secondary outcomes did not differ between groups. CONCLUSIONS: Awake prone positioning was not associated with lower intubation rates. Caution is necessary before widespread adoption of this technique, pending results of clinical trials.
BACKGROUND: Awake prone positioning has been widely used in patients with COVID-19respiratory failure to avoid intubation despite limited evidence. Our objective was to evaluate if prone positioning is associated with a reduced intubation rate when compared to usual care. METHODS: This was a retrospective cohort study in the emergency department of a large quaternary hospital in Sao Paulo. We retrieved data from all admitted patients in need of oxygen supplementation (>3 L/min) and tachypnea (>24 ipm) from March 1 to April 30, 2020, excluding those who had any contraindication to the prone position or who had an immediate need for intubation. The primary endpoint was endotracheal intubation up to 15 days. Secondary outcomes included a 6-point clinical outcome ordinal scale, mechanical ventilation-free days, admission to the intensive care unit, and need of hemodialysis and of vasoactive drugs, all assessed at or up to 15 days. We analyzed unadjusted and adjusted effect estimates with Cox proportional hazards models, logistic regression, quantile regression, and sensitivity analyses using propensity score models. RESULTS: Of 925 suspected COVID-19patients admitted off mechanical ventilation, 166 patients fulfilled inclusion and exclusion criteria: 57 were exposed to prone positioning and 109 to usual care. In the intervention group, 33 (58%) were intubated versus 53 (49%) in the control group. We observed no difference in intubation rates in the univariate analysis (hazard ratio = 1.21, 95% confidence interval [CI] = 0.78 to 1.88, p = 0.39) nor in the adjusted analysis (hazard ratio = 0.90, 95% CI = 0.55 to 1.49, p = 0.69). Results were robust to the sensitivity analyses. Secondary outcomes did not differ between groups. CONCLUSIONS: Awake prone positioning was not associated with lower intubation rates. Caution is necessary before widespread adoption of this technique, pending results of clinical trials.
Authors: Anastasios Kollias; Konstantinos G Kyriakoulis; Vasiliki Rapti; Ioannis P Trontzas; Thomas Nitsotolis; Konstantinos Syrigos; Garyphallia Poulakou Journal: In Vivo Date: 2022 Jan-Feb Impact factor: 2.155
Authors: Sasha Abdallah Fahme; Kathleen F Walsh; Vanessa Rouzier; Puja Chebrolu; Hyasinta Jaka; Justin Roy Kingery; Fouad M Fouad; Jyoti S Mathad; Jennifer A Downs; Margaret McNairy Journal: Fam Med Community Health Date: 2021-04
Authors: Prashant Nasa; Elie Azoulay; Ashish K Khanna; Ravi Jain; Sachin Gupta; Yash Javeri; Deven Juneja; Pradeep Rangappa; Krishnaswamy Sundararajan; Waleed Alhazzani; Massimo Antonelli; Yaseen M Arabi; Jan Bakker; Laurent J Brochard; Adam M Deane; Bin Du; Sharon Einav; Andrés Esteban; Ognjen Gajic; Samuel M Galvagno; Claude Guérin; Samir Jaber; Gopi C Khilnani; Younsuck Koh; Jean-Baptiste Lascarrou; Flavia R Machado; Manu L N G Malbrain; Jordi Mancebo; Michael T McCurdy; Brendan A McGrath; Sangeeta Mehta; Armand Mekontso-Dessap; Mervyn Mer; Michael Nurok; Pauline K Park; Paolo Pelosi; John V Peter; Jason Phua; David V Pilcher; Lise Piquilloud; Peter Schellongowski; Marcus J Schultz; Manu Shankar-Hari; Suveer Singh; Massimiliano Sorbello; Ravindranath Tiruvoipati; Andrew A Udy; Tobias Welte; Sheila N Myatra Journal: Crit Care Date: 2021-03-16 Impact factor: 9.097
Authors: Ludhmila Abrahão Hajjar; Isabela Bispo Santos da Silva Costa; Stephanie Itala Rizk; Bruno Biselli; Brenno Rizerio Gomes; Cristina Salvadori Bittar; Gisele Queiroz de Oliveira; Juliano Pinheiro de Almeida; Mariana Vieira de Oliveira Bello; Cibele Garzillo; Alcino Costa Leme; Moizo Elena; Fernando Val; Marcela de Almeida Lopes; Marcus Vinícius Guimarães Lacerda; José Antonio Franchini Ramires; Roberto Kalil Filho; Jean-Louis Teboul; Giovanni Landoni Journal: Ann Intensive Care Date: 2021-02-18 Impact factor: 6.925
Authors: Jose Loureiro-Amigo; Cecilia Suárez-Carantoña; Isabel Oriol; Cristina Sánchez-Díaz; Ana Coloma-Conde; Luis Manzano-Espinosa; Manuel Rubio-Rivas; Barbara Otero-Perpiñá; María Mercedes Ferreiro-Mazón Jenaro; Ainara Coduras-Erdozain; José Luis Garcia-Klepzig; Derly Vargas-Parra; Paula M Pesqueira-Fontán; Isabel Fiteni-Mera; Gema María García-García; José Jiménez-Torres; Pablo Rodríguez-Cortés; Clara Costo-Muriel; Francisco Arnalich-Fernández; Arturo Artero; Francisco Javier Carrasco-Sánchez; Joaquín Escobar-Sevilla; José Nicolás Alcalá-Pedrajas; Ricardo Gómez-Huelgas; José-Manuel Ramos-Rincón Journal: Arch Bronconeumol Date: 2021-06-06 Impact factor: 4.872
Authors: Jacob Rosén; Erik von Oelreich; Diddi Fors; Malin Jonsson Fagerlund; Knut Taxbro; Peter Frykholm Journal: Crit Care Date: 2021-08-04 Impact factor: 9.097