Early awake proning in critical and severe COVID-19 patients undergoing noninvasive respiratory support: A retrospective multicenter cohort study
| Autor: | Luca Tabbì, Giulia Bruzzi, Enrico Clini, Linda Manicardi, Stefano Nava, Stefano Busani, Gabriele Corsi, Cristina Mussini, Irene Prediletto, Vittoria Comellini, Roberto D'Amico, Ilaria Bassi, Riccardo Fantini, Ivana Castaniere, Federico Tagariello, Massimo Girardis, Filippo Gozzi, Marco Carpano, Lara Pisani, Alessandro Marchioni, Roberto Tonelli, Dario Andrisani |
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| Přispěvatelé: | Tonelli R., Pisani L., Tabbi L., Comellini V., Prediletto I., Fantini R., Marchioni A., Andrisani D., Gozzi F., Bruzzi G., Manicardi L., Busani S., Mussini C., Castaniere I., Bassi I., Carpano M., Tagariello F., Corsi G., d'Amico R., Girardis M., Nava S., Clini E. |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Pulmonary and Respiratory Medicine
Coronavirus disease 2019 (COVID-19) ARF acute respiratory failure Vt tidal volume medicine.medical_treatment RR respiratory rate Acute respiratory failure NRS non-invasive respiratory support law.invention Cohort Studies 03 medical and health sciences Prone position 0302 clinical medicine Randomized controlled trial law ICU Intensive Care Unit medicine Humans Intubation 030212 general & internal medicine Wakefulness APACHE II acute physiology and chronic health evaluation II score HFNC High Flow Nasal Cannulae Retrospective Studies COVID-19 Acute respiratory failure Non-invasive mechanical ventilation Prone position NIV non-invasive mechanical ventilation business.industry ETI endotracheal intubation CPAP continuous positive airways pressure Confounding COVID-19 MV mechanical ventilation Retrospective cohort study SAPS II simplified acute physiology score PSV pressure support ventilation HR hazard ratio SOFA subsequent organ failure assessment OR odds ratio 030228 respiratory system PEEP positive end expiratory pressure Anesthesia Breathing Original Article Non-invasive mechanical ventilation Respiratory Insufficiency business Cohort study |
| Zdroj: | Pulmonology |
| Popis: | BACKGROUND/MATERIALS AND METHODS: This retrospective cohort study was conducted in two teaching hospitals over a 3-month period (March 2010-June 2020) comparing severe and critical COVID-19 patients admitted to Respiratory Intensive Care Unit for non-invasive respiratory support (NRS) and subjected to awake prone position (PP) with those receiving standard care (SC). Primary outcome was endotracheal intubation (ETI) rate. In-hospital mortality, time to ETI, tracheostomy, length of RICU and hospital stay served as secondary outcomes. Risk factors associated to ETI among PP patients were also investigated. RESULTS: A total of 114 patients were included, 76 in the SC and 38 in the PP group. Unadjusted Kaplan-Meier estimates showed greater effect of PP compared to SC on ETI rate (HRâ¯=â¯0.45 95% CI [0.2-0.9], pâ¯=â¯0.02) even after adjustment for baseline confounders (HRâ¯=â¯0.59 95% CI [0.3-0.94], pâ¯=â¯0.03). After stratification according to non-invasive respiratory support, PP showed greater significant benefit for those on High Flow Nasal Cannulae (HRâ¯=â¯0.34 95% CI [0.12-0.84], pâ¯=â¯0.04). Compared to SC, PP patients also showed a favorable difference in terms of days free from respiratory support, length of RICU and hospital stay while mortality and tracheostomy rate were not significantly different. CONCLUSIONS: Prone positioning in awake and spontaneously breathing Covid-19 patients is feasible and associated with a reduction of intubation rate, especially in those patients undergoing HFNC. Although our results are intriguing, further randomized controlled trials are needed to answer all the open questions remaining pending about the real efficacy of PP in this setting. |
| Databáze: | OpenAIRE |
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