tetano
Editor, Senior Moderator
Eur Respir J
. 2021 Jul 15;2100265.
doi: 10.1183/13993003.00265-2021. Online ahead of print.
Awake prone positioning and oxygen therapy in patients with COVID-19: The APRONOX study
Orlando R Perez-Nieto[SUP] 1 [/SUP], Diego Escarraman-Martinez[SUP] 2 [/SUP], Manuel A Guerrero-Gutierrez[SUP] 3 [/SUP], Eder I Zamarron-Lopez[SUP] 4 [/SUP], Javier Mancilla-Galindo[SUP] 5 6 [/SUP], Ashuin Kammar-García[SUP] 7 [/SUP], Miguel A Martinez-Camacho[SUP] 8 [/SUP], Ernesto Deloya-Tomás[SUP] 1 [/SUP], Jesús S Sanchez-Diaz[SUP] 9 [/SUP], Luis A Macías-García[SUP] 10 [/SUP], Raúl Soriano-Orozco[SUP] 11 [/SUP], Gabriel Cruz-Sánchez[SUP] 12 [/SUP], José D Salmeron-Gonzalez[SUP] 13 [/SUP], Marco A Toledo-Rivera[SUP] 14 [/SUP], Ivette Mata-Maqueda[SUP] 15 [/SUP], Luis A Morgado-Villaseñor[SUP] 16 [/SUP], Jenner J Martinez-Mazariegos[SUP] 17 [/SUP], Raymundo Flores Ramirez[SUP] 18 [/SUP], Josue L Medina-Estrada[SUP] 19 [/SUP], Silvio A Ñamendys-Silva[SUP] 3 20 [/SUP], APRONOX group
Affiliations
Abstract
The awake prone position (AP) strategy for patients with acute respiratory distress syndrome (ARDS) is a safe, simple, and cost-effective technique used to improve hypoxemia. We aimed to evaluate intubation and mortality risk in patients with coronavirus disease (COVID-19) who underwent AP during hospitalisation.In this retrospective, multicentre observational study conducted between May 1 and June 12, 2020 in 27 hospitals in Mexico and Ecuador, non-intubated patients with COVID-19 managed with AP or supine positioning were included to evaluate intubation and mortality risk through logistic regression models; multivariable and centre adjustment, propensity score analyses, and E-values were calculated to limit confounding. This study was registered at https://clinicaltrials.gov/ct2/show/NCT04407468827 non-intubated patients with COVID-19 in the AP (n=505) and supine (n=322) groups were included for analysis. Less patients in the AP group required endotracheal intubation (23.6% versus 40.4%) or died (20% versus 37.9%). AP was a protective factor for intubation even after multivariable adjustment (OR=0.39, 95%CI: 0.28-0.56, p<0.0001, E-value=2.01), which prevailed after propensity score analysis (OR=0.32, 95%CI: 0.21-0.49, p<0.0001, E-value=2.21), and mortality (adjusted OR=0.38, 95%CI: 0.25-0.57, p<0.0001, E-value=1.98). The main variables associated with intubation amongst AP patients were increasing age, lower baseline SpO[SUB]2[/SUB]/FiO[SUB]2[/SUB], and management with a non-rebreather mask.AP in hospitalised non-intubated patients with COVID-19 is associated with a lower risk of intubation and mortality.
. 2021 Jul 15;2100265.
doi: 10.1183/13993003.00265-2021. Online ahead of print.
Awake prone positioning and oxygen therapy in patients with COVID-19: The APRONOX study
Orlando R Perez-Nieto[SUP] 1 [/SUP], Diego Escarraman-Martinez[SUP] 2 [/SUP], Manuel A Guerrero-Gutierrez[SUP] 3 [/SUP], Eder I Zamarron-Lopez[SUP] 4 [/SUP], Javier Mancilla-Galindo[SUP] 5 6 [/SUP], Ashuin Kammar-García[SUP] 7 [/SUP], Miguel A Martinez-Camacho[SUP] 8 [/SUP], Ernesto Deloya-Tomás[SUP] 1 [/SUP], Jesús S Sanchez-Diaz[SUP] 9 [/SUP], Luis A Macías-García[SUP] 10 [/SUP], Raúl Soriano-Orozco[SUP] 11 [/SUP], Gabriel Cruz-Sánchez[SUP] 12 [/SUP], José D Salmeron-Gonzalez[SUP] 13 [/SUP], Marco A Toledo-Rivera[SUP] 14 [/SUP], Ivette Mata-Maqueda[SUP] 15 [/SUP], Luis A Morgado-Villaseñor[SUP] 16 [/SUP], Jenner J Martinez-Mazariegos[SUP] 17 [/SUP], Raymundo Flores Ramirez[SUP] 18 [/SUP], Josue L Medina-Estrada[SUP] 19 [/SUP], Silvio A Ñamendys-Silva[SUP] 3 20 [/SUP], APRONOX group
Affiliations
- PMID: 34266942
- DOI: 10.1183/13993003.00265-2021
Abstract
The awake prone position (AP) strategy for patients with acute respiratory distress syndrome (ARDS) is a safe, simple, and cost-effective technique used to improve hypoxemia. We aimed to evaluate intubation and mortality risk in patients with coronavirus disease (COVID-19) who underwent AP during hospitalisation.In this retrospective, multicentre observational study conducted between May 1 and June 12, 2020 in 27 hospitals in Mexico and Ecuador, non-intubated patients with COVID-19 managed with AP or supine positioning were included to evaluate intubation and mortality risk through logistic regression models; multivariable and centre adjustment, propensity score analyses, and E-values were calculated to limit confounding. This study was registered at https://clinicaltrials.gov/ct2/show/NCT04407468827 non-intubated patients with COVID-19 in the AP (n=505) and supine (n=322) groups were included for analysis. Less patients in the AP group required endotracheal intubation (23.6% versus 40.4%) or died (20% versus 37.9%). AP was a protective factor for intubation even after multivariable adjustment (OR=0.39, 95%CI: 0.28-0.56, p<0.0001, E-value=2.01), which prevailed after propensity score analysis (OR=0.32, 95%CI: 0.21-0.49, p<0.0001, E-value=2.21), and mortality (adjusted OR=0.38, 95%CI: 0.25-0.57, p<0.0001, E-value=1.98). The main variables associated with intubation amongst AP patients were increasing age, lower baseline SpO[SUB]2[/SUB]/FiO[SUB]2[/SUB], and management with a non-rebreather mask.AP in hospitalised non-intubated patients with COVID-19 is associated with a lower risk of intubation and mortality.