ABSTRACT
INTRODUCTION: Since the early pandemic, prone positioning (PP) has been broadly utilized for non-intubated COVID-19 patients, but results from recently published randomized controlled trials (RCTs) are contradictory. We aimed to systematically synthesize the outcomes associated with PP for non-intubated COVID-19 patients. METHOD(S): Two independent groups of researchers searched MEDLINE, Embase, PubMed, Web of Science, Scopus, and ClinicalTrials.gov for RCTs of PP in nonintubated adult patients with COVID-19 and published in English from January 1st, 2020 to July 1st, 2022. The same two independent groups extracted the data and assessed the risk of bias. We used a random-effects meta-analysis to pool individual studies and the GRADE approach to assess certainty/quality of the evidence. The primary outcome was the reported cumulative intubation risk, while secondary outcomes included mortality, need for escalating respiratory support, hospital length of stay, ICU admission, and adverse events. The study protocol was prospectively registered with PROSPERO, CRD42022343625. RESULT(S): 12 RCTs with 2,886 patients were included. For non-intubated COVID-19 patients, PP significantly reduced the intubation risk (risk ratio [RR] 0.85, 95%CI 0.75 to 0.96), compared to supine position. Subgroup analysis showed a significant reduction in intubation risk among patients supported by high-flow nasal cannula (HFNC) or noninvasive ventilation (NIV) (RR 0.83, 95%CI 0.73 to 0.94) but not in patients with conventional oxygen therapy (RR 1.02, 95%CI 0.67 to 1.56). No significant reduction was seen in mortality (RR 0.96, 95%CI 0.82 to 1.13), need for escalating respiratory support (RR 1.03, 95%CI 0.77 to 1.37), hospital length of stay (MD 0.35 days, 95%CI -0.57 to 1.26), ICU admission (RR 0.75, 95%CI 0.51 to 1.10), and adverse events. No obvious risk of bias and publication bias was found for the primary outcome. CONCLUSION(S): In non-intubated COVID-19 patients, PP reduced the need for intubation, in particular among those requiring respiratory support with HFNC or NIV, but did not reduce mortality, need for escalating respiratory support, hospital length of stay, and ICU admission.
ABSTRACT
Introduction: The AFTERCOR study was developed by the COVID-19 Critical Care Consortium (>7000 intensive care unit [ICU] and >400 extracorporeal membrane oxygenation [ECMO] patients currently) to enhance understanding of occurrence and progression of long-term dysfunction post-COVID-19. Design: Prospective longitudinal (24 months) study of ICU survivors of COVID-19 to describe recovery of the following aspects: a) health-related quality of life b) dynamics of organ dysfunction and recovery and c) pulmonary function. Countries involved Italy, Spain, Ireland, Austria, South Africa, Australia, USA, Argentina, Brazil, Colombia. Protocol specifics available at https://www.aftercorstudy.com. Inclusion Criteria: 1) COVID-19 infection requiring ICU admission;2) informed consent;3) age ≥18 years. Exclusion Criteria: 1) pregnancy;2) pre-COVID paralysis;3) history of pulmonary resection;4) prior lung transplant;5) inability to perform 6-min walk test or participate in interview. Methods: Goal enrollment is 1000 patients. Follow-up visits are at 3, 6, 12, 18 and 24-month post-ICU discharge. Assessments include: 1) Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36);2) Montreal Cognitive Assessment;3) any subsequent admission 4) St. George's Respiratory Questionnaire;5) Pulmonary function testing;6) chest radiography;7) 6-minute-walk test;8) Patient Health Questionnaire 9 (PHQ-9) and 9) full blood count and biochemistry. CT chest at 6 months and repeat ECHO at 3, 12 and 24 months if performed during COVID-19 hospitalization. If results are normal, subsequent testing will not be performed. Summary: The AFTERCOR study represents a comprehensive evaluation for long-term effects from COVID-19. Interested centers are sought and invited to participate.
ABSTRACT
This paper reports on the progress in the project COVIGILANT, which is aimed at developing an evaluation taxonomy for Contact Tracing Applications (CTAs) for COVID-19. Specifically, this article describes the development of Usability, one pillar of the COVIGILANT taxonomy, discussing the classification and decision-making processes, and the initial model validation. The validation process was undertaken in two stages. First, we validated how the Usability pillar could be used to evaluate the Irish Health Services Executive (HSE) COVID-19 CTA. While this supported many of the attributes that we had within the Usability pillar, it also identified issues. We made amendments based on these, and undertook a second study, this time evaluating 4 CTAs used in other countries. This has led to the completion of the Usability pillar, which can now be used to evaluate global CTAs.