tetano
Editor, Senior Moderator
Acute Med Surg
. 2022 Jun 4;9(1):e765.
doi: 10.1002/ams2.765. eCollection Jan-Dec 2022.
PaO [SUB]2[/SUB] / FiO [SUB]2[/SUB] ratio responsiveness to prone positioning in intubated patients with severe COVID-19: a retrospective observational study
Akiko Kawakami[SUP] 1 [/SUP], Kazuma Yamakawa[SUP] 1 [/SUP], Daisuke Nishioka[SUP] 2 [/SUP], Koshi Ota[SUP] 1 [/SUP], Yusuke Kusaka[SUP] 3 [/SUP], Osamu Umegaki[SUP] 4 [/SUP], Yuri Ito[SUP] 2 [/SUP], Akira Takasu[SUP] 1 [/SUP]
Affiliations
Abstract
Aim: Prone positioning of coronavirus disease 2019 (COVID-19) patients could improve oxygenation. However, clinical data on prone positioning of intubated COVID-19 patients are limited. We investigated trends of PaO[SUB]2[/SUB] / FiO[SUB]2[/SUB] ratio values in patients during prone positioning to identify a predictive factor for early detection of patients requiring advanced therapeutic intervention such as extracorporeal membrane oxygenation (ECMO).
Methods: This retrospective, observational cohort study was undertaken between April 2020 and May 2021 in a tertiary referral hospital for COVID-19 in Osaka, Japan. We included intubated adult COVID-19 patients treated with prone positioning within the first 72 h of admission to the intensive care unit and followed them until hospital discharge or death. Primary outcomes were in-hospital mortality and escalation of care to ECMO. We used unsupervised k-means clustering modeling to categorize COVID-19 patients by PaO[SUB]2[/SUB] / FiO[SUB]2[/SUB] ratio responsiveness to prone positioning.
Results: The final study cohort comprised 54 of 155 consecutive severe COVID-19 patients. Three clusters were generated according to trends in PaO[SUB]2[/SUB] / FiO[SUB]2[/SUB] ratios during prone positioning (cluster A, n = 16; cluster B, n = 24; cluster C, n = 14). Baseline characteristics of all clusters were almost similar. Cluster A (no increase in PaO[SUB]2[/SUB] / FiO[SUB]2[/SUB] ratio during prone positioning) had a significantly higher proportion of patients placed on ECMO or who died (6/16, 37.5%). Numbers of patients with ECMO and with in-hospital death were significantly different between the three groups (p = 0.017).
Conclusion: In Japanese patients intubated due to COVID-19, clinicians should consider earlier escalation of treatment, such as facility transfer or ECMO, if the PaO[SUB]2[/SUB] / FiO[SUB]2[/SUB] ratio does not increase during initial prone positioning.
Keywords: Acute respiratory distress syndrome; COVID‐19; ECMO; PaO2 / FiO2 ratio; prone positioning.
. 2022 Jun 4;9(1):e765.
doi: 10.1002/ams2.765. eCollection Jan-Dec 2022.
PaO [SUB]2[/SUB] / FiO [SUB]2[/SUB] ratio responsiveness to prone positioning in intubated patients with severe COVID-19: a retrospective observational study
Akiko Kawakami[SUP] 1 [/SUP], Kazuma Yamakawa[SUP] 1 [/SUP], Daisuke Nishioka[SUP] 2 [/SUP], Koshi Ota[SUP] 1 [/SUP], Yusuke Kusaka[SUP] 3 [/SUP], Osamu Umegaki[SUP] 4 [/SUP], Yuri Ito[SUP] 2 [/SUP], Akira Takasu[SUP] 1 [/SUP]
Affiliations
- PMID: 35677680
- PMCID: PMC9167425
- DOI: 10.1002/ams2.765
Abstract
Aim: Prone positioning of coronavirus disease 2019 (COVID-19) patients could improve oxygenation. However, clinical data on prone positioning of intubated COVID-19 patients are limited. We investigated trends of PaO[SUB]2[/SUB] / FiO[SUB]2[/SUB] ratio values in patients during prone positioning to identify a predictive factor for early detection of patients requiring advanced therapeutic intervention such as extracorporeal membrane oxygenation (ECMO).
Methods: This retrospective, observational cohort study was undertaken between April 2020 and May 2021 in a tertiary referral hospital for COVID-19 in Osaka, Japan. We included intubated adult COVID-19 patients treated with prone positioning within the first 72 h of admission to the intensive care unit and followed them until hospital discharge or death. Primary outcomes were in-hospital mortality and escalation of care to ECMO. We used unsupervised k-means clustering modeling to categorize COVID-19 patients by PaO[SUB]2[/SUB] / FiO[SUB]2[/SUB] ratio responsiveness to prone positioning.
Results: The final study cohort comprised 54 of 155 consecutive severe COVID-19 patients. Three clusters were generated according to trends in PaO[SUB]2[/SUB] / FiO[SUB]2[/SUB] ratios during prone positioning (cluster A, n = 16; cluster B, n = 24; cluster C, n = 14). Baseline characteristics of all clusters were almost similar. Cluster A (no increase in PaO[SUB]2[/SUB] / FiO[SUB]2[/SUB] ratio during prone positioning) had a significantly higher proportion of patients placed on ECMO or who died (6/16, 37.5%). Numbers of patients with ECMO and with in-hospital death were significantly different between the three groups (p = 0.017).
Conclusion: In Japanese patients intubated due to COVID-19, clinicians should consider earlier escalation of treatment, such as facility transfer or ECMO, if the PaO[SUB]2[/SUB] / FiO[SUB]2[/SUB] ratio does not increase during initial prone positioning.
Keywords: Acute respiratory distress syndrome; COVID‐19; ECMO; PaO2 / FiO2 ratio; prone positioning.