ABSTRACT
BACKGROUND: The awake prone positioning strategy for patients with acute respiratory distress syndrome is a safe, simple and cost-effective technique used to improve hypoxaemia. We aimed to evaluate intubation and mortality risk in patients with coronavirus disease 2019 (COVID-19) who underwent awake prone positioning during hospitalisation. METHODS: In this retrospective, multicentre observational study conducted between 1 May 2020 and 12 June 2020 in 27 hospitals in Mexico and Ecuador, nonintubated patients with COVID-19 managed with awake prone or awake supine positioning were included to evaluate intubation and mortality risk through logistic regression models; multivariable and centre adjustment, propensity score analyses, and E-values were calculated to limit confounding. RESULTS: 827 nonintubated patients with COVID-19 in the awake prone (n=505) and awake supine (n=322) groups were included for analysis. Fewer patients in the awake prone group required endotracheal intubation (23.6% versus 40.4%) or died (19.8% versus 37.3%). Awake prone positioning was a protective factor for intubation even after multivariable adjustment (OR 0.35, 95% CI 0.24-0.52; p<0.0001, E=2.12), which prevailed after propensity score analysis (OR 0.41, 95% CI 0.27-0.62; p<0.0001, E=1.86) and mortality (adjusted OR 0.38, 95% CI 0.26-0.55; p<0.0001, E=2.03). The main variables associated with intubation among awake prone patients were increasing age, lower baseline peripheral arterial oxygen saturation/inspiratory oxygen fraction ratio (P aO2 /F IO2 ) and management with a nonrebreather mask. CONCLUSIONS: Awake prone positioning in hospitalised nonintubated patients with COVID-19 is associated with a lower risk of intubation and mortality.
Subject(s)
COVID-19 , Respiratory Insufficiency , COVID-19/therapy , Humans , Oxygen/therapeutic use , Prone Position , Respiratory Insufficiency/therapy , Retrospective Studies , SARS-CoV-2 , WakefulnessABSTRACT
OBJECTIVE: Determine whether the levels of glycated hemoglobin (HbA1c) measured on admission to the intensive care unit (ICU) are associated with mortality in patients with severe SARS-CoV-2 pneumonia with invasive mechanical ventilation. DESIGN: Cohort study, retrospective, observational. A single center. PLACE: ICU of a second-level care hospital. PATIENTS: Severe SARS-CoV-2 pneumonia confirmed with IMV since admission to the ICU. INTERVENTIONS: none. RESULTS: A total of 56 patients with severe pneumonia, confirmed with SARS-CoV-2, all with IMV. The group with HbA1c <6.5% included 32 (57.14%) patients and the group with HbA1c ≥6.5% included 24 (42.86%) patients and the mortality rate in ICU was 43.8% and 70.8%, respectively, with p = 0.04. Predictors of mortality at 28 days in ICU were DHL >500 U/L, OR 3.65 (95% CI 1.18-11.29), HbA1c ≥6.5%, OR 3.12 (95% CI 1.01-9.6), SAH, OR 3.12 (95% CI 1.01-9.5), use of vasopressor, OR 0.2 (95% CI 0.05-0.73), diabetes was not statistically significant. CONCLUSION: The 28-day probability of survival in patients with severe SARS-CoV-2 pneumonia with IMV in the ICU is lower when the HbA1c level is ≥6.5% on admission.