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Crit Care Sci
. 2024 Dec 20:36:e20240065en.
doi: 10.62675/2965-2774.20240065-en. eCollection 2024. Comparison of the effectiveness of awake-prone positioning and high-flow nasal oxygen in patients with COVID-19-related acute respiratory failure between different waves
[Article in English, Portuguese]
Mariano Esperatti 1 , Matías Olmos 1 , Marina Busico 2 , Adrian Gallardo 3 , Alejandra Vitali 4 , Jorgelina Quintana 2 , Hiromi Kakisu 1 , Bruno Leonel Ferreyro 5 , Nora Angélica Fuentes 1 ; Argentine Collaborative Group on High Flow and Prone Positioning; Javier Osatnik 6 , Santiago Nicolas Saavedra 6 , Agustin Matarrese 6 , Greta Dennise Rebaza Niquin 6 , Elizabeth Gisele Wasinger 7 , Giuliana Mast 7 , Facundo Juan Andrada 7 , Ana Inés Lagazio 8 , Nahuel Esteban Romano 8 , Marisol Mariela Laiz 8 , Jose Garcia Urrutia 8 , Mariela Adriana Mogaadouro 4 , Micaela Ruiz Seifert 4 , Emilce Mastroberti 4 , Claudia Navarro Moreno 9 , Anabel Miranda Tirado 9 , María Constanza Viñas 9 , Juan Manuel Pintos 9 , Maria Eugenia Gonzalez 9 , Maite Mateos 9 , Verónica Barbaresi 9 , Ana Elizabeth Grimbeek 9 , Leonel Stein 9 , Ariel Juan Latronico 9 , Silvia Laura Menéndez 9 , Alejandra Dominga Basualdo 9 , Romina Castrillo 9
Affiliations
Objective: To compare the effectiveness of the awake-prone position on relevant clinical outcomes in patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen between different waves in Argentina.
Methods: This multicenter, prospective cohort study included adult patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen. The main exposure position was the awake-prone position (≥ 6 hours/day) compared to the non-prone position. The primary outcome was endotracheal intubation, and the secondary outcome was in-hospital mortality. The inverse probability weighting-propensity score was used to adjust the conditional probability of treatment assignment. We then adjusted for contextual variables that varied over time and compared the effectiveness between the first and second waves.
Results: A total of 728 patients were included: 360 during the first wave and 368 during the second wave, of whom 195 (54%) and 227 (62%) remained awake-prone for a median (p25 - 75) of 12 (10 - 16) and 14 (8 - 17) hours/day, respectively (Awake-Prone Position Group). The ORs (95%CIs) for endotracheal intubation in the Awake-Prone Position Group were 0.25 (0.13 - 0.46) and 0.19 (0.09 - 0.31) for the first and second waves, respectively (p = 0.41 for comparison between waves). The ORs for in-hospital mortality in the awake-prone position were 0.35 (0.17 - 0.65) and 0.22 (0.12 - 0.43), respectively (p = 0.44 for comparison between waves).
Conclusion: The awake-prone position was associated with a reduction in the risk of endotracheal intubation and in-hospital mortality. These effects were independent of the context in which the intervention was applied, and no differences were observed between the different waves.
Trial registration: ClinicalTrials.gov NCT05178212.
. 2024 Dec 20:36:e20240065en.
doi: 10.62675/2965-2774.20240065-en. eCollection 2024. Comparison of the effectiveness of awake-prone positioning and high-flow nasal oxygen in patients with COVID-19-related acute respiratory failure between different waves
[Article in English, Portuguese]
Mariano Esperatti 1 , Matías Olmos 1 , Marina Busico 2 , Adrian Gallardo 3 , Alejandra Vitali 4 , Jorgelina Quintana 2 , Hiromi Kakisu 1 , Bruno Leonel Ferreyro 5 , Nora Angélica Fuentes 1 ; Argentine Collaborative Group on High Flow and Prone Positioning; Javier Osatnik 6 , Santiago Nicolas Saavedra 6 , Agustin Matarrese 6 , Greta Dennise Rebaza Niquin 6 , Elizabeth Gisele Wasinger 7 , Giuliana Mast 7 , Facundo Juan Andrada 7 , Ana Inés Lagazio 8 , Nahuel Esteban Romano 8 , Marisol Mariela Laiz 8 , Jose Garcia Urrutia 8 , Mariela Adriana Mogaadouro 4 , Micaela Ruiz Seifert 4 , Emilce Mastroberti 4 , Claudia Navarro Moreno 9 , Anabel Miranda Tirado 9 , María Constanza Viñas 9 , Juan Manuel Pintos 9 , Maria Eugenia Gonzalez 9 , Maite Mateos 9 , Verónica Barbaresi 9 , Ana Elizabeth Grimbeek 9 , Leonel Stein 9 , Ariel Juan Latronico 9 , Silvia Laura Menéndez 9 , Alejandra Dominga Basualdo 9 , Romina Castrillo 9
Affiliations
- PMID: 39775433
- DOI: 10.62675/2965-2774.20240065-en
Objective: To compare the effectiveness of the awake-prone position on relevant clinical outcomes in patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen between different waves in Argentina.
Methods: This multicenter, prospective cohort study included adult patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen. The main exposure position was the awake-prone position (≥ 6 hours/day) compared to the non-prone position. The primary outcome was endotracheal intubation, and the secondary outcome was in-hospital mortality. The inverse probability weighting-propensity score was used to adjust the conditional probability of treatment assignment. We then adjusted for contextual variables that varied over time and compared the effectiveness between the first and second waves.
Results: A total of 728 patients were included: 360 during the first wave and 368 during the second wave, of whom 195 (54%) and 227 (62%) remained awake-prone for a median (p25 - 75) of 12 (10 - 16) and 14 (8 - 17) hours/day, respectively (Awake-Prone Position Group). The ORs (95%CIs) for endotracheal intubation in the Awake-Prone Position Group were 0.25 (0.13 - 0.46) and 0.19 (0.09 - 0.31) for the first and second waves, respectively (p = 0.41 for comparison between waves). The ORs for in-hospital mortality in the awake-prone position were 0.35 (0.17 - 0.65) and 0.22 (0.12 - 0.43), respectively (p = 0.44 for comparison between waves).
Conclusion: The awake-prone position was associated with a reduction in the risk of endotracheal intubation and in-hospital mortality. These effects were independent of the context in which the intervention was applied, and no differences were observed between the different waves.
Trial registration: ClinicalTrials.gov NCT05178212.