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Early versus late awake prone positioning in non-intubated patients with COVID-19.
Kaur, Ramandeep; Vines, David L; Mirza, Sara; Elshafei, Ahmad; Jackson, Julie A; Harnois, Lauren J; Weiss, Tyler; Scott, J Brady; Trump, Matthew W; Mogri, Idrees; Cerda, Flor; Alolaiwat, Amnah A; Miller, Amanda R; Klein, Andrew M; Oetting, Trevor W; Morris, Lindsey; Heckart, Scott; Capouch, Lindsay; He, Hangyong; Li, Jie.
  • Kaur R; Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 600 S Paulina St, Suite 765, Chicago, IL, USA.
  • Vines DL; Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 600 S Paulina St, Suite 765, Chicago, IL, USA.
  • Mirza S; Division of Pulmonary, Critical Care, and Sleep Medicine, Rush University Medical Center, Chicago, IL, USA.
  • Elshafei A; Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 600 S Paulina St, Suite 765, Chicago, IL, USA.
  • Jackson JA; Department of Respiratory Care, Unity Point Health-Des Moines, Des Moines, IA, USA.
  • Harnois LJ; Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 600 S Paulina St, Suite 765, Chicago, IL, USA.
  • Weiss T; Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 600 S Paulina St, Suite 765, Chicago, IL, USA.
  • Scott JB; Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 600 S Paulina St, Suite 765, Chicago, IL, USA.
  • Trump MW; The Iowa Clinic P.C. and Unity Point Health-Des Moines, Des Moines, IA, USA.
  • Mogri I; Pulmonary and Critical Care Medicine Division, Texas A&M School of Medicine, Baylor University Medical Center, Dallas, TX, USA.
  • Cerda F; Nursing, MICU, Rush University Medical Center, Chicago, IL, USA.
  • Alolaiwat AA; Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 600 S Paulina St, Suite 765, Chicago, IL, USA.
  • Miller AR; Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 600 S Paulina St, Suite 765, Chicago, IL, USA.
  • Klein AM; Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 600 S Paulina St, Suite 765, Chicago, IL, USA.
  • Oetting TW; Department of Respiratory Care, Unity Point Health-Des Moines, Des Moines, IA, USA.
  • Morris L; Pulmonary and Critical Care Medicine Division, Texas A&M School of Medicine, Baylor University Medical Center, Dallas, TX, USA.
  • Heckart S; Department of Respiratory Care, Unity Point Health-Des Moines, Des Moines, IA, USA.
  • Capouch L; Department of Respiratory Care, Unity Point Health-Des Moines, Des Moines, IA, USA.
  • He H; Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
  • Li J; Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 600 S Paulina St, Suite 765, Chicago, IL, USA. Jie_Li@rush.edu.
Crit Care ; 25(1): 340, 2021 09 17.
Article in English | MEDLINE | ID: covidwho-1594693
ABSTRACT

BACKGROUND:

Awake prone positioning (APP) is widely used in the management of patients with coronavirus disease (COVID-19). The primary objective of this study was to compare the outcome of COVID-19 patients who received early versus late APP.

METHODS:

Post hoc analysis of data collected for a randomized controlled trial (ClinicalTrials.gov NCT04325906). Adult patients with acute hypoxemic respiratory failure secondary to COVID-19 who received APP for at least one hour were included. Early prone positioning was defined as APP initiated within 24 h of high-flow nasal cannula (HFNC) start. Primary outcomes were 28-day mortality and intubation rate.

RESULTS:

We included 125 patients (79 male) with a mean age of 62 years. Of them, 92 (73.6%) received early APP and 33 (26.4%) received late APP. Median time from HFNC initiation to APP was 2.25 (0.8-12.82) vs 36.35 (30.2-75.23) hours in the early and late APP group (p < 0.0001), respectively. Average APP duration was 5.07 (2.0-9.05) and 3.0 (1.09-5.64) hours per day in early and late APP group (p < 0.0001), respectively. The early APP group had lower mortality compared to the late APP group (26% vs 45%, p = 0.039), but no difference was found in intubation rate. Advanced age (OR 1.12 [95% CI 1.0-1.95], p = 0.001), intubation (OR 10.65 [95% CI 2.77-40.91], p = 0.001), longer time to initiate APP (OR 1.02 [95% CI 1.0-1.04], p = 0.047) and hydrocortisone use (OR 6.2 [95% CI 1.23-31.1], p = 0.027) were associated with increased mortality.

CONCLUSIONS:

Early initiation (< 24 h of HFNC use) of APP in acute hypoxemic respiratory failure secondary to COVID-19 improves 28-day survival. Trial registration ClinicalTrials.gov NCT04325906.
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Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Oxygen Inhalation Therapy / Respiratory Distress Syndrome / Wakefulness / Prone Position / COVID-19 Type of study: Experimental Studies / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Female / Humans / Male / Middle aged Language: English Journal: Crit Care Year: 2021 Document Type: Article Affiliation country: S13054-021-03761-9

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Oxygen Inhalation Therapy / Respiratory Distress Syndrome / Wakefulness / Prone Position / COVID-19 Type of study: Experimental Studies / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Female / Humans / Male / Middle aged Language: English Journal: Crit Care Year: 2021 Document Type: Article Affiliation country: S13054-021-03761-9