Comparison of the effectiveness of awake-prone positioning and high-flow nasal oxygen in patients with COVID-19-related acute respiratory failure between different waves.

Autor: Esperatti M; Intensive Care Department, Hospital Privado de Comunidad, Escuela Superior de Medicina, Universidad Nacional de Mar del Plata - Mar del Plata, Argentina., Olmos M; Intensive Care Department, Hospital Privado de Comunidad, Escuela Superior de Medicina, Universidad Nacional de Mar del Plata - Mar del Plata, Argentina., Busico M; Intensive Care Unit, Clínica Olivos, Swiss Medical Group - Buenos Aires, Argentina., Gallardo A; Intensive Care Unit, Sanatorio Clínica Modelo de Morón - Buenos Aires, Argentina., Vitali A; Intensive Care Unit, Sanatorio de la Trinidad Palermo - Buenos Aires, Argentina., Quintana J; Intensive Care Unit, Clínica Olivos, Swiss Medical Group - Buenos Aires, Argentina., Kakisu H; Intensive Care Department, Hospital Privado de Comunidad, Escuela Superior de Medicina, Universidad Nacional de Mar del Plata - Mar del Plata, Argentina., Ferreyro BL; Interdepartmental Division of Critical Care Medicine, University of Toronto - Toronto, Canada., Fuentes NA; Intensive Care Department, Hospital Privado de Comunidad, Escuela Superior de Medicina, Universidad Nacional de Mar del Plata - Mar del Plata, Argentina., Osatnik J; Intensive Care Unit, Hospital Alemão - Buenos Aires, Argentina., Saavedra SN; Intensive Care Unit, Hospital Alemão - Buenos Aires, Argentina., Matarrese A; Intensive Care Unit, Hospital Alemão - Buenos Aires, Argentina., Niquin GDR; Intensive Care Unit, Hospital Alemão - Buenos Aires, Argentina., Wasinger EG; Intensive Care Unit, Hospital Universitario Austral - Buenos Aires, Argentina., Mast G; Intensive Care Unit, Hospital Universitario Austral - Buenos Aires, Argentina., Andrada FJ; Intensive Care Unit, Hospital Universitario Austral - Buenos Aires, Argentina., Lagazio AI; Intensive Care Unit, Clínica Olivos - Buenos Aires, Argentina., Romano NE; Intensive Care Unit, Clínica Olivos - Buenos Aires, Argentina., Laiz MM; Intensive Care Unit, Clínica Olivos - Buenos Aires, Argentina., Urrutia JG; Intensive Care Unit, Clínica Olivos - Buenos Aires, Argentina., Mogaadouro MA; Intensive Care Unit, Sanatorio de la Trinidad Palermo - Buenos Aires, Argentina., Seifert MR; Intensive Care Unit, Sanatorio de la Trinidad Palermo - Buenos Aires, Argentina., Mastroberti E; Intensive Care Unit, Sanatorio de la Trinidad Palermo - Buenos Aires, Argentina., Moreno CN; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina., Tirado AM; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina., Viñas MC; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina., Pintos JM; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina., Gonzalez ME; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina., Mateos M; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina., Barbaresi V; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina., Grimbeek AE; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina., Stein L; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina., Latronico AJ; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina., Menéndez SL; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina., Basualdo AD; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina., Castrillo R; Intensive Care Department, Hospital Privado de Comunidad - Mar del Plata, Argentina.
Jazyk: English; Portuguese
Zdroj: Critical care science [Crit Care Sci] 2024 Oct 21; Vol. 36, pp. e20240065en. Date of Electronic Publication: 2024 Oct 21 (Print Publication: 2024).
DOI: 10.62675/2965-2774.20240065-en
Abstrakt: Objective: To compare the effectiveness of the awake-prone position on relevant clinical outcomes in patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen between different waves in Argentina.
Methods: This multicenter, prospective cohort study included adult patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen. The main exposure position was the awake-prone position (≥ 6 hours/day) compared to the non-prone position. The primary outcome was endotracheal intubation, and the secondary outcome was in-hospital mortality. The inverse probability weighting-propensity score was used to adjust the conditional probability of treatment assignment. We then adjusted for contextual variables that varied over time and compared the effectiveness between the first and second waves.
Results: A total of 728 patients were included: 360 during the first wave and 368 during the second wave, of whom 195 (54%) and 227 (62%) remained awake-prone for a median (p25 - 75) of 12 (10 - 16) and 14 (8 - 17) hours/day, respectively (Awake-Prone Position Group). The ORs (95%CIs) for endotracheal intubation in the Awake-Prone Position Group were 0.25 (0.13 - 0.46) and 0.19 (0.09 - 0.31) for the first and second waves, respectively (p = 0.41 for comparison between waves). The ORs for in-hospital mortality in the awake-prone position were 0.35 (0.17 - 0.65) and 0.22 (0.12 - 0.43), respectively (p = 0.44 for comparison between waves).
Conclusion: The awake-prone position was associated with a reduction in the risk of endotracheal intubation and in-hospital mortality. These effects were independent of the context in which the intervention was applied, and no differences were observed between the different waves.
Databáze: MEDLINE
Externí odkaz: