Factors for success of awake prone positioning in patients with COVID-19-induced acute hypoxemic respiratory failure : analysis of a randomized controlled trial
© 2022. The Author(s)..
BACKGROUND: Awake prone positioning (APP) improves oxygenation in coronavirus disease (COVID-19) patients and, when successful, may decrease the risk of intubation. However, factors associated with APP success remain unknown. In this secondary analysis, we aimed to assess whether APP can reduce intubation rate in patients with COVID-19 and to focus on the factors associated with success.
METHODS: In this multicenter randomized controlled trial, conducted in three high-acuity units, we randomly assigned patients with COVID-19-induced acute hypoxemic respiratory failure (AHRF) requiring high-flow nasal cannula (HFNC) oxygen to APP or standard care. Primary outcome was intubation rate at 28 days. Multivariate analyses were performed to identify the predictors associated to treatment success (survival without intubation).
RESULTS: Among 430 patients randomized, 216 were assigned to APP and 214 to standard care. The APP group had a lower intubation rate (30% vs 43%, relative risk [RR] 0.70; CI95 0.54-0.90, P = 0.006) and shorter hospital length of stay (11 interquartile range [IQR, 9-14] vs 13 [IQR, 10-17] days, P = 0.001). A respiratory rate ≤ 25 bpm at enrollment, an increase in ROX index > 1.25 after first APP session, APP duration > 8 h/day, and a decrease in lung ultrasound score ≥ 2 within the first 3 days were significantly associated with treatment success for APP.
CONCLUSION: In patients with COVID-19-induced AHRF treated by HFNC, APP reduced intubation rate and improved treatment success. A longer APP duration is associated with APP success, while the increase in ROX index and decrease in lung ultrasound score after APP can also help identify patients most likely to benefit.
TRIAL REGISTRATION: This study was retrospectively registered in ClinicalTrials.gov at July 20, 2021. Identification number NCT04477655. https://clinicaltrials.gov/ct2/show/NCT04477655?term=PRO-CARF&draw=2&rank=1.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
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| Enthalten in: |
Critical care (London, England) - 26(2022), 1 vom: 28. März, Seite 84 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ibarra-Estrada, Miguel [VerfasserIn] |
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| Links: |
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| Themen: |
Acute hypoxemic respiratory failure |
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| Anmerkungen: |
Date Completed 31.03.2022 Date Revised 01.04.2022 published: Electronic ClinicalTrials.gov: NCT04477655 Citation Status MEDLINE |
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| doi: |
10.1186/s13054-022-03950-0 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
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| 100 | 1 | |a Ibarra-Estrada, Miguel |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Factors for success of awake prone positioning in patients with COVID-19-induced acute hypoxemic respiratory failure |b analysis of a randomized controlled trial |
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| 500 | |a Date Completed 31.03.2022 | ||
| 500 | |a Date Revised 01.04.2022 | ||
| 500 | |a published: Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT04477655 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022. The Author(s). | ||
| 520 | |a BACKGROUND: Awake prone positioning (APP) improves oxygenation in coronavirus disease (COVID-19) patients and, when successful, may decrease the risk of intubation. However, factors associated with APP success remain unknown. In this secondary analysis, we aimed to assess whether APP can reduce intubation rate in patients with COVID-19 and to focus on the factors associated with success | ||
| 520 | |a METHODS: In this multicenter randomized controlled trial, conducted in three high-acuity units, we randomly assigned patients with COVID-19-induced acute hypoxemic respiratory failure (AHRF) requiring high-flow nasal cannula (HFNC) oxygen to APP or standard care. Primary outcome was intubation rate at 28 days. Multivariate analyses were performed to identify the predictors associated to treatment success (survival without intubation) | ||
| 520 | |a RESULTS: Among 430 patients randomized, 216 were assigned to APP and 214 to standard care. The APP group had a lower intubation rate (30% vs 43%, relative risk [RR] 0.70; CI95 0.54-0.90, P = 0.006) and shorter hospital length of stay (11 interquartile range [IQR, 9-14] vs 13 [IQR, 10-17] days, P = 0.001). A respiratory rate ≤ 25 bpm at enrollment, an increase in ROX index > 1.25 after first APP session, APP duration > 8 h/day, and a decrease in lung ultrasound score ≥ 2 within the first 3 days were significantly associated with treatment success for APP | ||
| 520 | |a CONCLUSION: In patients with COVID-19-induced AHRF treated by HFNC, APP reduced intubation rate and improved treatment success. A longer APP duration is associated with APP success, while the increase in ROX index and decrease in lung ultrasound score after APP can also help identify patients most likely to benefit | ||
| 520 | |a TRIAL REGISTRATION: This study was retrospectively registered in ClinicalTrials.gov at July 20, 2021. Identification number NCT04477655. https://clinicaltrials.gov/ct2/show/NCT04477655?term=PRO-CARF&draw=2&rank=1 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Acute hypoxemic respiratory failure | |
| 650 | 4 | |a Awake prone positioning | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Intubation | |
| 700 | 1 | |a Li, Jie |e verfasserin |4 aut | |
| 700 | 1 | |a Pavlov, Ivan |e verfasserin |4 aut | |
| 700 | 1 | |a Perez, Yonatan |e verfasserin |4 aut | |
| 700 | 1 | |a Roca, Oriol |e verfasserin |4 aut | |
| 700 | 1 | |a Tavernier, Elsa |e verfasserin |4 aut | |
| 700 | 1 | |a McNicholas, Bairbre |e verfasserin |4 aut | |
| 700 | 1 | |a Vines, David |e verfasserin |4 aut | |
| 700 | 1 | |a Marín-Rosales, Miguel |e verfasserin |4 aut | |
| 700 | 1 | |a Vargas-Obieta, Alexandra |e verfasserin |4 aut | |
| 700 | 1 | |a García-Salcido, Roxana |e verfasserin |4 aut | |
| 700 | 1 | |a Aguirre-Díaz, Sara A |e verfasserin |4 aut | |
| 700 | 1 | |a López-Pulgarín, José A |e verfasserin |4 aut | |
| 700 | 1 | |a Chávez-Peña, Quetzalcóatl |e verfasserin |4 aut | |
| 700 | 1 | |a Mijangos-Méndez, Julio C |e verfasserin |4 aut | |
| 700 | 1 | |a Aguirre-Avalos, Guadalupe |e verfasserin |4 aut | |
| 700 | 1 | |a Ehrmann, Stephan |e verfasserin |4 aut | |
| 700 | 1 | |a Laffey, John G |e verfasserin |4 aut | |
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