tetano
Editor, Senior Moderator
Acute Med Surg
. 2022 Feb 12;9(1):e734.
doi: 10.1002/ams2.734. eCollection Jan-Dec 2022.
Efficacy of awake prone positioning for severe illness coronavirus disease 2019 patients: a propensity score-adjusted cohort study
Kenji Numata[SUP] 1 [/SUP], Daiki Kobayashi[SUP] 2 [/SUP], Tomohiro Hosoda[SUP] 3 [/SUP], Yutaka Saito[SUP] 4 [/SUP], Ayu Minoura[SUP] 1 [/SUP], Satsuki Yamazaki[SUP] 1 [/SUP], Shigeki Fujitani[SUP] 1 [/SUP]
Affiliations
Abstract
Aim: Awake prone positioning (PP) in patients with coronavirus disease 2019 (COVID-19) can improve oxygenation. However, evidence showing that it can prevent intubation is lacking. This study investigated the efficacy of awake PP in patients with COVID-19 who received remdesivir, dexamethasone, and anticoagulant therapy.
Methods: This was a two-center cohort study. Patients admitted to the severe COVID-19 patient unit were included. The primary outcome was the intubation rate and secondary outcome was length of stay in the severe COVID-19 unit. After propensity score adjustment, we undertook multivariable regression to calculate the estimates of outcomes between patients who received awake PP and those who did not.
Results: Overall, 108 patients were included (54 [50.0%] patients each who did and did not undergo awake PP), of whom 25 (23.2%) were intubated (with awake PP, 5 [9.3%] vs. without awake PP, 20 [37.0%]; P < 0.01). The median length of stay in the severe COVID-19 unit did not significantly differ (with awake PP, 5 days vs. without awake PP, 5.5 days; P = 0.68). After propensity score adjustment, those who received awake PP had a lower intubation rate than those who did not (odds ratio, 0.22; 95% confidence interval, 0.06-0.85; P = 0.03). Length of stay in the severe COVID-19 patient unit did not differ significantly (adjusted percentage difference, -24.4%; 95% confidence interval, -56.3% to 30.8%; P = 0.32).
Conclusion: Awake PP could be correlated with intubation rate in patients with COVID-19 who are receiving remdesivir, dexamethasone, and anticoagulant therapy.
Keywords: Coronavirus disease 2019; dexamethasone; intubation; prone positioning; respiratory failure.
. 2022 Feb 12;9(1):e734.
doi: 10.1002/ams2.734. eCollection Jan-Dec 2022.
Efficacy of awake prone positioning for severe illness coronavirus disease 2019 patients: a propensity score-adjusted cohort study
Kenji Numata[SUP] 1 [/SUP], Daiki Kobayashi[SUP] 2 [/SUP], Tomohiro Hosoda[SUP] 3 [/SUP], Yutaka Saito[SUP] 4 [/SUP], Ayu Minoura[SUP] 1 [/SUP], Satsuki Yamazaki[SUP] 1 [/SUP], Shigeki Fujitani[SUP] 1 [/SUP]
Affiliations
- PMID: 35169487
- PMCID: PMC8840898
- DOI: 10.1002/ams2.734
Abstract
Aim: Awake prone positioning (PP) in patients with coronavirus disease 2019 (COVID-19) can improve oxygenation. However, evidence showing that it can prevent intubation is lacking. This study investigated the efficacy of awake PP in patients with COVID-19 who received remdesivir, dexamethasone, and anticoagulant therapy.
Methods: This was a two-center cohort study. Patients admitted to the severe COVID-19 patient unit were included. The primary outcome was the intubation rate and secondary outcome was length of stay in the severe COVID-19 unit. After propensity score adjustment, we undertook multivariable regression to calculate the estimates of outcomes between patients who received awake PP and those who did not.
Results: Overall, 108 patients were included (54 [50.0%] patients each who did and did not undergo awake PP), of whom 25 (23.2%) were intubated (with awake PP, 5 [9.3%] vs. without awake PP, 20 [37.0%]; P < 0.01). The median length of stay in the severe COVID-19 unit did not significantly differ (with awake PP, 5 days vs. without awake PP, 5.5 days; P = 0.68). After propensity score adjustment, those who received awake PP had a lower intubation rate than those who did not (odds ratio, 0.22; 95% confidence interval, 0.06-0.85; P = 0.03). Length of stay in the severe COVID-19 patient unit did not differ significantly (adjusted percentage difference, -24.4%; 95% confidence interval, -56.3% to 30.8%; P = 0.32).
Conclusion: Awake PP could be correlated with intubation rate in patients with COVID-19 who are receiving remdesivir, dexamethasone, and anticoagulant therapy.
Keywords: Coronavirus disease 2019; dexamethasone; intubation; prone positioning; respiratory failure.