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Early awake proning in critical and severe COVID-19 patients undergoing noninvasive respiratory support: A retrospective multicenter cohort study.
Tonelli, Roberto; Pisani, Lara; Tabbì, Luca; Comellini, Vittoria; Prediletto, Irene; Fantini, Riccardo; Marchioni, Alessandro; Andrisani, Dario; Gozzi, Filippo; Bruzzi, Giulia; Manicardi, Linda; Busani, Stefano; Mussini, Cristina; Castaniere, Ivana; Bassi, Ilaria; Carpano, Marco; Tagariello, Federico; Corsi, Gabriele; d'Amico, Roberto; Girardis, Massimo; Nava, Stefano; Clini, Enrico.
  • Tonelli R; University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy. Electronic address: roberto.tonelli@m
  • Pisani L; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy. Electronic address: lara.pisani@aosp.bo.it.
  • Tabbì L; University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy. Electronic address: lucatabbi@gmail.com.
  • Comellini V; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy. Electronic address: vittoria.comellini@gmail.com.
  • Prediletto I; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy. Electronic address: irene.prediletto@gmail.com.
  • Fantini R; University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy. Electronic address: fantini.riccardo@yahoo.it.
  • Marchioni A; University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy. Electronic address: marchioni.alessandro@unimore.it.
  • Andrisani D; University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy. Electronic address: darioandrisani@libero.it.
  • Gozzi F; University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy. Electronic address: 72683@studenti.unimore.it.
  • Bruzzi G; University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy. Electronic address: giulibru92@gmail.com.
  • Manicardi L; University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy. Electronic address: linda.manicardi3@gmail.com.
  • Busani S; University Hospital of Modena, Intensive Care Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplants Oncology and Regenerative Medicine, University of Modena Reggio Emilia, Modena, Italy. Electronic address: stefano.busani@unimore.it.
  • Mussini C; University Hospital of Modena, Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy. Electronic address: cristina.mussini@unimore.it.
  • Castaniere I; University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy. Electronic address: ivana.castaniere@
  • Bassi I; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy. Electronic address: ilaria.bassi6@gmail.com.
  • Carpano M; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy. Electronic address: marco.carpano@gmail.com.
  • Tagariello F; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy. Electronic address: tagariellof@gmail.com.
  • Corsi G; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy. Electronic address: gabrielepcorsi@gmail.com.
  • d'Amico R; Statistics Unit, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy. Electronic address: roberto.damico@unimore.it.
  • Girardis M; University Hospital of Modena, Intensive Care Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplants Oncology and Regenerative Medicine, University of Modena Reggio Emilia, Modena, Italy.
  • Nava S; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy. Electronic address: stefano.nava@unibo.it.
  • Clini E; University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy. Electronic address: enrico.clini@unimore.it.
Pulmonology ; 28(3): 181-192, 2022.
Article in English | MEDLINE | ID: covidwho-1144904
Semantic information from SemMedBD (by NLM)
1. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
2. Teaching Hospitals LOCATION_OF Retrospective Cohort Study
Subject
Teaching Hospitals
Predicate
LOCATION_OF
Object
Retrospective Cohort Study
3. risk factors PROCESS_OF Patients
Subject
risk factors
Predicate
PROCESS_OF
Object
Patients
4. Prone positioning TREATS Patients
Subject
Prone positioning
Predicate
TREATS
Object
Patients
5. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
6. Teaching Hospitals LOCATION_OF Retrospective Cohort Study
Subject
Teaching Hospitals
Predicate
LOCATION_OF
Object
Retrospective Cohort Study
7. risk factors PROCESS_OF Patients
Subject
risk factors
Predicate
PROCESS_OF
Object
Patients
8. Prone positioning TREATS Patients
Subject
Prone positioning
Predicate
TREATS
Object
Patients
ABSTRACT
BACKGROUND/MATERIALS AND

METHODS:

This retrospective cohort study was conducted in two teaching hospitals over a 3-month period (March 2010-June 2020) comparing severe and critical COVID-19 patients admitted to Respiratory Intensive Care Unit for non-invasive respiratory support (NRS) and subjected to awake prone position (PP) with those receiving standard care (SC). Primary outcome was endotracheal intubation (ETI) rate. In-hospital mortality, time to ETI, tracheostomy, length of RICU and hospital stay served as secondary outcomes. Risk factors associated to ETI among PP patients were also investigated.

RESULTS:

A total of 114 patients were included, 76 in the SC and 38 in the PP group. Unadjusted Kaplan-Meier estimates showed greater effect of PP compared to SC on ETI rate (HR = 0.45 95% CI [0.2-0.9], p = 0.02) even after adjustment for baseline confounders (HR = 0.59 95% CI [0.3-0.94], p = 0.03). After stratification according to non-invasive respiratory support, PP showed greater significant benefit for those on High Flow Nasal Cannulae (HR = 0.34 95% CI [0.12-0.84], p = 0.04). Compared to SC, PP patients also showed a favorable difference in terms of days free from respiratory support, length of RICU and hospital stay while mortality and tracheostomy rate were not significantly different.

CONCLUSIONS:

Prone positioning in awake and spontaneously breathing Covid-19 patients is feasible and associated with a reduction of intubation rate, especially in those patients undergoing HFNC. Although our results are intriguing, further randomized controlled trials are needed to answer all the open questions remaining pending about the real efficacy of PP in this setting.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Insufficiency / COVID-19 Type of study: Controlled clinical trial / Etiology study / Incidence study / Observational study / Randomized controlled trials / Risk factors Limits: Humans Language: English Journal: Pulmonology Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Insufficiency / COVID-19 Type of study: Controlled clinical trial / Etiology study / Incidence study / Observational study / Randomized controlled trials / Risk factors Limits: Humans Language: English Journal: Pulmonology Year: 2022 Document Type: Article