Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study
Abstract Background Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HF...
Main Authors: | , , , , , , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2020-10-01
|
Series: | Critical Care |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s13054-020-03314-6 |
id |
doaj-09a1e12a92bb457ea60b87431fefd2d3 |
---|---|
record_format |
Article |
spelling |
doaj-09a1e12a92bb457ea60b87431fefd2d32020-11-25T02:46:29ZengBMCCritical Care1364-85352020-10-0124111110.1186/s13054-020-03314-6Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort studyCarlos Ferrando0Ricard Mellado-Artigas1Alfredo Gea2Egoitz Arruti3César Aldecoa4Ramón Adalia5Fernando Ramasco6Pablo Monedero7Emilio Maseda8Gonzalo Tamayo9María L. Hernández-Sanz10Jordi Mercadal11Ascensión Martín-Grande12Robert M. Kacmarek13Jesús Villar14Fernando Suárez-Sipmann15for the COVID-19 Spanish ICU NetworkDepartment of Anesthesiology and Critical Care, Hospital Clínic, Institut D’investigació August Pi i SunyerDepartment of Anesthesiology and Critical Care, Hospital Clínic, Institut D’investigació August Pi i SunyerDepartment of Preventive Medicine and Public Health, University of NavarraUbikare TechnologyDepartment of Anesthesiology and Critical Care, Hospital Universitario Río HortegaDepartment of Anesthesiology and Critical Care, Hospital del MarDepartment of Anesthesiology and Critical Care, Hospital Universitario La PrincesaDepartment of Anesthesiology and Intensive Care, Clínica Universitaria de NavarraDepartment of Anesthesiology and Critical Care, Hospital Universitario La PazDepartment of Anesthesiology and Critical Care, Hospital Universitario de CrucesDepartment of Anesthesiology and Critical Care, Hospital Universitario de CrucesDepartment of Anesthesiology and Critical Care, Hospital Clínic, Institut D’investigació August Pi i SunyerDepartment of Anesthesiology and Critical Care, Hospital Universitario Ramón y CajalDepartment of Respiratory Care, Massachusetts General HospitalCIBER de Enfermedades Respiratorias, Instituto de Salud Carlos IIICIBER de Enfermedades Respiratorias, Instituto de Salud Carlos IIIAbstract Background Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone. Methods Prospective, multicenter, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory Sequential Organ Failure Assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate, and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP. Results A total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO + awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95% CI 0.53–1.43), p = 0.60]. Patients treated with HFNO + awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0–2.5) vs 2 IQR 1.0–3.0] days (p = 0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95% CI 0.40–2.72), p = 0.92]. Conclusion In patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality.http://link.springer.com/article/10.1186/s13054-020-03314-6Acute respiratory failureCOVID-19High-flow nasal oxygen therapyProne positioningMechanical ventilationCritical care |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Carlos Ferrando Ricard Mellado-Artigas Alfredo Gea Egoitz Arruti César Aldecoa Ramón Adalia Fernando Ramasco Pablo Monedero Emilio Maseda Gonzalo Tamayo María L. Hernández-Sanz Jordi Mercadal Ascensión Martín-Grande Robert M. Kacmarek Jesús Villar Fernando Suárez-Sipmann for the COVID-19 Spanish ICU Network |
spellingShingle |
Carlos Ferrando Ricard Mellado-Artigas Alfredo Gea Egoitz Arruti César Aldecoa Ramón Adalia Fernando Ramasco Pablo Monedero Emilio Maseda Gonzalo Tamayo María L. Hernández-Sanz Jordi Mercadal Ascensión Martín-Grande Robert M. Kacmarek Jesús Villar Fernando Suárez-Sipmann for the COVID-19 Spanish ICU Network Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study Critical Care Acute respiratory failure COVID-19 High-flow nasal oxygen therapy Prone positioning Mechanical ventilation Critical care |
author_facet |
Carlos Ferrando Ricard Mellado-Artigas Alfredo Gea Egoitz Arruti César Aldecoa Ramón Adalia Fernando Ramasco Pablo Monedero Emilio Maseda Gonzalo Tamayo María L. Hernández-Sanz Jordi Mercadal Ascensión Martín-Grande Robert M. Kacmarek Jesús Villar Fernando Suárez-Sipmann for the COVID-19 Spanish ICU Network |
author_sort |
Carlos Ferrando |
title |
Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study |
title_short |
Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study |
title_full |
Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study |
title_fullStr |
Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study |
title_full_unstemmed |
Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study |
title_sort |
awake prone positioning does not reduce the risk of intubation in covid-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2020-10-01 |
description |
Abstract Background Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone. Methods Prospective, multicenter, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory Sequential Organ Failure Assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate, and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP. Results A total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO + awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95% CI 0.53–1.43), p = 0.60]. Patients treated with HFNO + awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0–2.5) vs 2 IQR 1.0–3.0] days (p = 0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95% CI 0.40–2.72), p = 0.92]. Conclusion In patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality. |
topic |
Acute respiratory failure COVID-19 High-flow nasal oxygen therapy Prone positioning Mechanical ventilation Critical care |
url |
http://link.springer.com/article/10.1186/s13054-020-03314-6 |
work_keys_str_mv |
AT carlosferrando awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT ricardmelladoartigas awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT alfredogea awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT egoitzarruti awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT cesaraldecoa awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT ramonadalia awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT fernandoramasco awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT pablomonedero awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT emiliomaseda awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT gonzalotamayo awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT marialhernandezsanz awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT jordimercadal awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT ascensionmartingrande awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT robertmkacmarek awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT jesusvillar awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT fernandosuarezsipmann awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy AT forthecovid19spanishicunetwork awakepronepositioningdoesnotreducetheriskofintubationincovid19treatedwithhighflownasaloxygentherapyamulticenteradjustedcohortstudy |
_version_ |
1724757987292086272 |