Prone positioning for patients with SARS-CoV-2-related respiratory failure in non-intensive care unit
Abstract Background Prone positioning (PP) is an established and commonly used lung recruitment method for intubated patients with severe acute respiratory distress syndrome, with potential benefits in clinical outcome. The role of PP outside the intensive care unit (ICU) setting is debated. We aimed at describing the use and potential benefits of PP in non-intubated patients with acute respiratory failure related to COronaVIrus Disease-19 (COVID-19)-pneumonia. Methods Consecutive adult patients with COVID-19-related respiratory failure were included in a prospective collaborative cohort and classified based on the severity of respiratory failure by the partial arterial oxygen pressure to fraction of inspired oxygen ratio (PaO2/FiO2) and on clinical severity by the quick Sequential Organ Failure Assessment (qSOFA) score. Primary study outcome was the composite of in-hospital death or ICU admission within 30 days from hospitalization. Results PP was used in 114 of 536 study patients (21.8%), more commonly in patients with lower PaO2/FiO2 or receiving non-invasive ventilation and less commonly in patients with known comorbidities. A primary study outcome event occurred in 163 patients (30.4%) and was in-hospital death in 129 (24.1%). PP was not associated with death or ICU admission (HR 1.15, CI 95% 0.78-1.72) and not with death (HR 1.03, CI 95% 0.62-1.69); PP was an independent predictor of ICU admission (HR 2.55, 95%CI 1.50-4.32). The severity of respiratory failure and non-invasive ventilation were independent predictors of death or ICU admission at 30 days. The lack of association between PP and death or ICU admission was confirmed at propensity score matching analysis.Conclusion PP is used in a not negligible proportion of non-intubated patients with COVID-19-related severe respiratory failure and is not associated with death but with ICU admission. The role of PP in this setting requires evaluation in randomized studies..
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Preprint| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
ResearchSquare.com - (2022) vom: 15. Feb. Zur Gesamtaufnahme - year:2022 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
Graziani, Mara [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| doi: |
10.21203/rs.3.rs-1312867/v1 |
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XRA035248386 |
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| 520 | |a Abstract Background Prone positioning (PP) is an established and commonly used lung recruitment method for intubated patients with severe acute respiratory distress syndrome, with potential benefits in clinical outcome. The role of PP outside the intensive care unit (ICU) setting is debated. We aimed at describing the use and potential benefits of PP in non-intubated patients with acute respiratory failure related to COronaVIrus Disease-19 (COVID-19)-pneumonia. Methods Consecutive adult patients with COVID-19-related respiratory failure were included in a prospective collaborative cohort and classified based on the severity of respiratory failure by the partial arterial oxygen pressure to fraction of inspired oxygen ratio (PaO2/FiO2) and on clinical severity by the quick Sequential Organ Failure Assessment (qSOFA) score. Primary study outcome was the composite of in-hospital death or ICU admission within 30 days from hospitalization. Results PP was used in 114 of 536 study patients (21.8%), more commonly in patients with lower PaO2/FiO2 or receiving non-invasive ventilation and less commonly in patients with known comorbidities. A primary study outcome event occurred in 163 patients (30.4%) and was in-hospital death in 129 (24.1%). PP was not associated with death or ICU admission (HR 1.15, CI 95% 0.78-1.72) and not with death (HR 1.03, CI 95% 0.62-1.69); PP was an independent predictor of ICU admission (HR 2.55, 95%CI 1.50-4.32). The severity of respiratory failure and non-invasive ventilation were independent predictors of death or ICU admission at 30 days. The lack of association between PP and death or ICU admission was confirmed at propensity score matching analysis.Conclusion PP is used in a not negligible proportion of non-intubated patients with COVID-19-related severe respiratory failure and is not associated with death but with ICU admission. The role of PP in this setting requires evaluation in randomized studies. | ||
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