Associations of Awake Prone Positioning-Induced Changes in Physiology with Intubation: An International Prospective Observational Study in Patients with Acute Hypoxemic Respiratory Failure Related to COVID-19
Issued Date
2023-01-01
Resource Type
ISSN
23641754
eISSN
23641746
Scopus ID
2-s2.0-85175580010
Journal Title
Pulmonary Therapy
Rights Holder(s)
SCOPUS
Bibliographic Citation
Pulmonary Therapy (2023)
Suggested Citation
Morales-Quinteros L., Scala R., Silva J.M., Leidi A., Leszek A., Vazquez-Guillamet R., Pascual S., Serpa-Neto A., Artigas A., Schultz M.J. Associations of Awake Prone Positioning-Induced Changes in Physiology with Intubation: An International Prospective Observational Study in Patients with Acute Hypoxemic Respiratory Failure Related to COVID-19. Pulmonary Therapy (2023). doi:10.1007/s41030-023-00242-y Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/90995
Title
Associations of Awake Prone Positioning-Induced Changes in Physiology with Intubation: An International Prospective Observational Study in Patients with Acute Hypoxemic Respiratory Failure Related to COVID-19
Author's Affiliation
Mahidol Oxford Tropical Medicine Research Unit
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
Gruppo Ospedaliero San Donato
Hospital Clinic Barcelona
University of Melbourne
Universitat Autònoma de Barcelona
Washington University School of Medicine in St. Louis
Monash University
Hospital Israelita Albert Einstein
Hospital Universitari de Bellvitge
Hôpitaux Universitaires de Genève
Nuffield Department of Medicine
Amsterdam UMC - University of Amsterdam
Hospital das Clínicas
Corporacion Sanitaria Universitaria Parc Taulí
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
Gruppo Ospedaliero San Donato
Hospital Clinic Barcelona
University of Melbourne
Universitat Autònoma de Barcelona
Washington University School of Medicine in St. Louis
Monash University
Hospital Israelita Albert Einstein
Hospital Universitari de Bellvitge
Hôpitaux Universitaires de Genève
Nuffield Department of Medicine
Amsterdam UMC - University of Amsterdam
Hospital das Clínicas
Corporacion Sanitaria Universitaria Parc Taulí
Other Contributor(s)
Abstract
Introduction: Awake prone positioning has the potential to improve oxygenation and decrease respiratory rate, potentially reducing the need for intubation in patients with acute hypoxemic respiratory failure. We investigated awake prone positioning-induced changes in oxygenation and respiratory rate, and the prognostic capacity for intubation in patients with COVID-19 pneumonia. Methods: International multicenter prospective observation study in critically ill adult patients with COVID-19 receiving supplemental oxygen. We collected data on oxygenation and respiratory rate at baseline, and at 1 h after being placed in prone positioning. The combined primary outcome was oxygenation and respiratory rate at 1 h. The secondary endpoint was treatment failure, defined as need for intubation within 24 h of start of awake prone positioning. Results: Between March 27th and November 2020, 101 patients were enrolled of which 99 were fully analyzable. Awake prone positioning lasted mean of 3 [2–4] h. In 77 patients (77.7%), awake prone positioning improved oxygenation, and in 37 patients (54.4%) it decreased respiratory rate. Twenty-nine patients (29.3%) were intubated within 24 h. An increase in SpO2/FiO2 of < 10 (OR 5.1, 95% CI 1.4–18.5, P = 0.01), a failure to increase PaO2/FiO2 to > 116 mmHg (OR 3.6, 95% CI 1.2–10.8, P = 0.02), and a decrease in respiratory rate of < 2 breaths/min (OR 3.6, 95% CI 1.3–9.5, P = 0.01) were independent variables associated with need for intubation. The AUC–ROC curve for intubation using a multivariable model was 0.73 (95% CI 0.62–0.84). Conclusions: Awake prone positioning improves oxygenation in the majority of patients, and decreases respiratory rate in more than half of patients with acute hypoxemic respiratory failure caused by COVID-19. One in three patients need intubation within 24 h. Awake prone position-induced changes in oxygenation and respiratory rate have prognostic capacity for intubation within 24 h.
