ABSTRACT
Resumen Introducción El prono en ventilación espontánea no es una estrategia reciente, y pese a los muchos años que lleva intentando consolidarse, no ha podido demostrar ser de real utilidad. Durante la reciente pandemia, el prono en ventilación espontánea resurgió como una alternativa práctica y simple, aunque muy cuestionada por su débil nivel de evidencia. Con el tiempo y la experiencia generada, de a poco fue relegada a convertirse únicamente en una atractiva hipótesis. Objetivo Este estudio busca analizar los potenciales beneficios del prono en ventilación espontánea en pacientes con hipoxemia producida por SARS-CoV-2. Método Se realizó una revisión panorámica de los estudios más relevantes publicados en las bases de datos MEDLINE, Embase y Scopus hasta el 20 de diciembre de 2021. Resultados Tras el escrutinio se eligieron para el análisis: 4 estudios observacionales, un ensayo clínico aleatorizado y 3 revisiones sistemáticas. Conclusiones Mediante análisis estadísticos concluimos que el prono en ventilación espontánea, si bien podría retrasar la intubación, no mejoraba la sobrevida de los sujetos hipoxémicos por neumonía viral causada por coronavirus tipo 2. Intoduction Prone position in spontaneous ventilation is not a recent strategy, and despite the many years it has been trying to consolidate, it has not been able to prove to be of real utility. During the recent pandemic, prone spontaneous ventilation re-emerged as a practical and simple alternative, although it was highly questioned due to its weak level of evidence. With time and experience, it was gradually relegated to become only an attractive hypothesis. Objective This study aims to analyze the potential benefits of prone position in spontaneous ventilation in patients with hypoxemia caused by SARS-CoV-2. Methods A panoramic review of the most relevant studies published in the MEDLINE, Embase and Scopus databases up to December 20, 2021 was performed. Results After screening, 4 observational studies, 1 randomized clinical trial, and 3 systematic reviews were selected for analysis. Conclusions By statistical analysis we concluded that prone position in spontaneous ventilation, although it could delay intubation, did not improve survival in hypoxemic subjects with viral pneumonia caused by coronavirus type 2.
ABSTRACT
Objective: To specify the degree of probative force of the statistical hypotheses in relation to mortality at 28 days and the threshold value of 17 J/min mechanical power (MP) in patients with respiratory failure secondary to SARS-CoV-2. Design: Cohort study, longitudinal, analytical. Setting: Intensive care unit of a third level hospital in Spain. Patients: Patients admitted for SARS-CoV-2 infection with admission to the ICU between March 2020 and March 2022. Interventions: Bayesian analysis with the beta binomial model. Main variables of interest: Bayes factor, mechanical power. Results: A total of 253 patients were analyzed. Baseline respiratory rate (BF10: 3.83 × 106), peak pressure value (BF10: 3.72 × 1013) and neumothorax (BF10: 17,663) were the values most likely to be different between the two groups of patients compared. In the group of patients with MP < 17 J/min, a BF10 of 12.71 and a BF01 of 0.07 were established with an 95%CI of 0.27-0.58. For the group of patients with MP ≥ 17 J/min the BF10 was 36,100 and the BF01 of 2.77e-05 with an 95%CI of 0.42-0.72. Conclusions: A MP ≥ 17 J/min value is associated with extreme evidence with 28-day mortality in patients requiring MV due to respiratory failure secondary to SARS-CoV-2 disease.
ABSTRACT
OBJECTIVE: To specify the degree of probative force of the statistical hypotheses in relation to mortality at 28 days and the threshold value of 17 J/min mechanical power (MP) in patients with respiratory failure secondary to SARS-CoV-2. DESIGN: Cohort study, longitudinal, analytical. SETTING: Intensive care unit of a third level hospital in Spain. PATIENTS: Patients admitted for SARS-CoV-2 infection with admission to the ICU between March 2020 and March 2022. INTERVENTIONS: Bayesian analysis with the beta binomial model. MAIN VARIABLES OF INTEREST: Bayes factor, mechanical power. RESULTS: A total of 253 patients were analyzed. Baseline respiratory rate (BF10: 3.83 × 106), peak pressure value (BF10: 3.72 × 1013) and neumothorax (BF10: 17,663) were the values most likely to be different between the two groups of patients compared. In the group of patients with MP < 17 J/min, a BF10 of 12.71 and a BF01 of 0.07 were established with an 95%CI of 0.27-0.58. For the group of patients with MP ≥ 17 J/min the BF10 was 36,100 and the BF01 of 2.77e-05 with an 95%CI of 0.42-0.72. CONCLUSIONS: A MP ≥ 17 J/min value is associated with extreme evidence with 28-day mortality in patients requiring MV due to respiratory failure secondary to SARS-CoV-2 disease.
ABSTRACT
Objective To specify the degree of probative force of the statistical hypotheses in relation to mortality at 28 days and the threshold value of 17 J/min mechanical power (MP) in patients with respiratory failure secondary to SARS-CoV-2. Design Cohort study, longitudinal, analytical. Setting Intensive care unit of a third level hospital in Spain. Patients Patients admitted for SARS-CoV-2 infection with admission to the ICU between March 2020 and March 2022. Interventions Bayesian analysis with the beta binomial model. Main variables of interest Bayes factor, mechanical power. Results A total of 253 patients were analyzed. Baseline respiratory rate (BF10: 3.83 × 106), peak pressure value (BF10: 3.72 × 1013) and neumothorax (BF10: 17,663) were the values most likely to be different between the two groups of patients compared. In the group of patients with MP < 17 J/min, a BF10 of 12.71 and a BF01 of 0.07 were established with an 95%CI of 0.27-0.58. For the group of patients with MP ≥ 17 J/min the BF10 was 36,100 and the BF01 of 2.77e-05 with an 95%CI of 0.42-0.72. Conclusions A MP ≥ 17 J/min value is associated with extreme evidence with 28-day mortality in patients requiring MV due to respiratory failure secondary to SARS-CoV-2 disease.