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Predictors of intubation in COVID-19 patients undergoing awake proning in the emergency department.
Downing, Jessica; Cardona, Stephanie; Alfalasi, Reem; Shadman, Shahrad; Dhahri, Amina; Paudel, Riddhi; Buchongo, Portia; Schwartz, Bradford; Tran, Quincy K.
  • Downing J; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: jvdowning@som.umaryland.edu.
  • Cardona S; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Alfalasi R; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
  • Shadman S; Department of Medicine, University of Maryland Capital Region Health, Cheverly, MD, USA.
  • Dhahri A; Department of Medicine, University of Maryland Capital Region Health, Cheverly, MD, USA.
  • Paudel R; Ross University School of Medicine, Miramar, FL, USA.
  • Buchongo P; Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD, USA.
  • Schwartz B; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Emergency Medicine, University of Maryland Capital Region Health, Prince George's Hospital Center, Cheverly, MD, USA.
  • Tran QK; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Am J Emerg Med ; 49: 276-286, 2021 11.
Article in English | MEDLINE | ID: covidwho-1281376
ABSTRACT

BACKGROUND:

Awake prone positioning (PP) has been used to avoid intubations in hypoxic COVID-19 patients, but there is limited evidence regarding its efficacy. Moreover, clinicians have little information to identify patients at high risk of intubation despite awake PP. We sought to assess the intubation rate among patients treated with awake PP in our Emergency Department (ED) and identify predictors of need for intubation.

METHODS:

We conducted a multicenter retrospective cohort study of adult patients admitted for known or suspected COVID-19 who were treated with awake PP in the ED. We excluded patients intubated in the ED. Our primary outcome was prevalence of intubation during initial hospitalization. Other outcomes were intubation within 48 h of admission and mortality. We performed classification and regression tree analysis to identify the variables most likely to predict the need for intubation.

RESULTS:

We included 97 patients; 44% required intubation and 21% were intubated within 48 h of admission. Respiratory oxygenation (ROX) index and P/F (partial pressure of oxygen / fraction of inspired oxygen) ratio measured 24 h after admission were the variables most likely to predict need for intubation (area under the receiver operating characteristic curve = 0.82).

CONCLUSIONS:

Among COVID-19 patients treated with awake PP in the ED prior to admission, ROX index and P/F ratio, particularly 24 h after admission, may be useful tools in identifying patients at high risk of intubation.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Wakefulness / Prone Position / COVID-19 / Intubation, Intratracheal / Hypoxia Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: Am J Emerg Med Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Wakefulness / Prone Position / COVID-19 / Intubation, Intratracheal / Hypoxia Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: Am J Emerg Med Year: 2021 Document Type: Article