ABSTRACT
Prone positioning is an immediately accessible, readily implementable intervention that was proposed initially as a method for improvement in gas exchange > 50 years ago. Initially implemented clinically as an empiric therapy for refractory hypoxemia, multiple clinical trials were performed on the use of prone positioning in various respiratory conditions, cumulating in the landmark PROSEVA trial, which demonstrated mortality benefit in patients with severe ARDS. After this trial and the corresponding meta-analysis, expert consensus and societal guidelines recommended the use of prone positioning for the management of severe ARDS. The ongoing COVID-19 pandemic has brought prone positioning to the forefront of medicine, including widespread implementation of prone positioning in awake, spontaneously breathing, nonintubated patients with acute hypoxemic respiratory failure. Multiple clinical trials now have been performed to investigate the safety and effectiveness of prone positioning in these patients and have enhanced our understanding of the effects of the prone position in respiratory failure. In this review, we discuss the physiologic features, clinical outcome data, practical considerations, and lingering questions of prone positioning.
ABSTRACT
BACKGROUND: The COVID-19 pandemic has imposed additional stress on population health that may result in a change of sleeping behavior. OBJECTIVE: In this study, we hypothesized that using natural language processing (NLP) to explore social media would help to assess the mental health condition of people experiencing insomnia after the outbreak of COVID-19. METHODS: We designed a retrospective study using public social media content from Twitter. We categorized insomnia-related tweets based on time into two intervals: pre-pandemic (01/01/2019 to 01/01/2020) and peri-pandemic (01/01/2020 to 01/01/2021). We performed sentiment analysis using pretrained transformers in conjunction with Dempster-Shafer theory (DST) to classify the polarity of emotions into positive, negative, and neutral. We validated the proposed pipeline on 300 annotated tweets. Additionally, we performed temporal analysis to examine the effect of time on the users' insomnia experience, using logistic regression. RESULTS: We extracted 305,321 tweets containing the word insomnia (pre-pandemic, 139,561 and peri-pandemic, 165,760). The best combination of pretrained transformers via DST yielded 84% accuracy. Next, using this pipeline, we found that the odds of negative tweets (OR, 1.39; 95% CI, 1.37-1.41, P<.001) were higher peri-pandemic compared to pre-pandemic. The likelihood of negative tweets after midnight was 21% higher than before midnight (OR, 1.21; 95%CI: 1.19-1.23, P<.001). Peri-pandemic, while the odds of negative tweets were 2% higher after midnight compared to before midnight (OR, 1.02; 95%CI: 1.00-1.07, P = .008), they were 43% higher (OR, 1.43; 95%CI: 1.40-1.46, P<.001) peri-pandemic. CONCLUSIONS: The proposed novel sentiment analysis pipeline that combines pretrained transformers by DST is capable of classifying the emotion or sentiment of insomnia-related tweets. Twitter users shared more negative tweets about insomnia peri-pandemic than pre-pandemic. Future studies using a natural language processing framework could assess tweets about other psychological distress, habit changes, weight gain due to inactivity, and the effect of viral infection on sleep.
ABSTRACT
BACKGROUND: Safe, effective, and easily implementable treatments that reduce the progression of respiratory failure in COVID-19 are urgently needed. Despite the increased adoption of prone positioning during the pandemic, the effectiveness of this technique on progression of respiratory failure among nonintubated patients is unclear. RESEARCH QUESTION: What is the effectiveness of smartphone-guided self-prone positioning recommendations and instructions compared with usual care in reducing progression of respiratory failure among nonintubated patients with COVID-19? STUDY DESIGN AND METHODS: Awake Prone Position for Early Hypoxemia in COVID-19 (APPEX-19) is a multicenter randomized clinical trial that randomized nonintubated adults with COVID-19 on < 6 L/min of supplemental oxygen to receive a smartphone-guided self-prone positioning intervention or usual care. The primary outcome was the composite of respiratory deterioration (an increase in supplemental oxygen requirement) or ICU transfer. Using a Bayesian statistical approach, the posterior probability of superiority within each treatment arm (superiority threshold 95%) was calculated. RESULTS: The trial was stopped early for slow enrollment. A total of 293 participants were included in the modified intention-to-treat analysis (159 self-prone positioning intervention and 134 usual care). Among participants who self-reported body positioning (n = 139 [70 intervention, 69 usual care]), 71.4% in the intervention arm and 59.4% in the usual care arm attempted prone positioning. Thirty-one participants (posterior mean, 24.7%; 95% credible interval, 18.6-31.4) receiving usual care and 32 participants (posterior mean, 22.1%; 95% credible interval, 16.6-28.1) receiving the self-prone positioning intervention experienced the primary outcome; the posterior probability of superiority for the self-prone positioning intervention was 72.1%, less than the 95% threshold for superiority. Adverse events occurred in 26.9% of participants in the usual care arm and in 11.9% of participants in the intervention arm. INTERPRETATION: Among nonintubated patients with COVID-19, smartphone-guided self-prone positioning recommendations and instructions did not promote strong adherence to prone positioning. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT04344587; URL: www. CLINICALTRIALS: gov.