Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34185
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.
Austin Authors: Morales-Quinteros, Luis;Scala, Raffaele;Silva, João Manoel;Leidi, Antonio;Leszek, Alexandre;Vazquez-Guillamet, Rodrigo;Pascual, Sergi;Serpa Neto, Ary ;Artigas, Antonio;Schultz, Marcus J
Affiliation: Department of Intensive Care Medicine, Hospital Universitari Sant Pau, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain.;Translational Research Laboratory, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona Sabadell, Sabadell, Spain.;CIBER Enfermedades Respiratorias (ISCiii), Madrid, Spain.
Pulmonology and RICU, S Donato Hospital, Arezzo, Italy.
Department of Anesthesiology, Hospital das Clinicas, Sao Paolo, Brazil.
General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.
Division of Pulmonary and Critical Care Medicine, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University, Saint Louis, MO, USA.
CIBER Enfermedades Respiratorias (ISCiii), Madrid, Spain.;Servei de Pneumologia, Departament de Ciències, Hospital del Mar-IMIM, Experimentals I de La Salut (CEXS], UniversitatPompeuFabra, Barcelona, Catalunya, Spain.
Department of Intensive Care & Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A], Amsterdam UMC Location AMC, Amsterdam, The Netherlands.;Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.;Australian and New Zealand Intensive Care Research Centre (ANZIC-RC], Monash University, Melbourne, Australia.
Translational Research Laboratory, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona Sabadell, Sabadell, Spain.;CIBER Enfermedades Respiratorias (ISCiii), Madrid, Spain.;Critical Care Center, Corporacion Sanitaria Universitaria Parc Taulí, Sabadell, Spain.
Department of Intensive Care & Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A], Amsterdam UMC Location AMC, Amsterdam, The Netherlands.;Nuffield Department of Medicine, Oxford University, Oxford, UK.;Mahidol-Oxford Tropical Medicine Research Unit (MORU], Mahidol University, Bangkok, Thailand.
Data Analytics Research and Evaluation (DARE) Centre
Issue Date: 2-Nov-2023
Date: 2023
Publication information: Pulmonary Therapy 2023-11-02
Abstract: 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. 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. 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). 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.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34185
DOI: 10.1007/s41030-023-00242-y
ORCID: 0000-0002-8937-9824
Journal: Pulmonary Therapy
PubMed URL: 37917322
ISSN: 2364-1746
Type: Journal Article
Subjects: Acute hypoxemic respiratory failure
Awake prone position
COVID-19
Coronavirus disease
Intubation
Prognostication
Self-proning
Appears in Collections:Journal articles

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