Early versus late awake prone positioning in non-intubated patients with COVID-19
Ramandeep Kaur,
David L. Vines,
Sara Mirza,
Ahmad Elshafei,
Julie A. Jackson,
Lauren J. Harnois,
Tyler Weiss,
J. Brady Scott,
Matthew W. Trump,
Idrees Mogri,
Flor Cerda,
Amnah A. Alolaiwat,
Amanda R. Miller,
Andrew M. Klein,
Trevor W. Oetting,
Lindsey Morris,
Scott Heckart,
Lindsay Capouch,
Hangyong He,
Jie Li
Affiliations
Ramandeep Kaur
Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center
David L. Vines
Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center
Sara Mirza
Division of Pulmonary, Critical Care, and Sleep Medicine, Rush University Medical Center
Ahmad Elshafei
Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center
Julie A. Jackson
Department of Respiratory Care, Unity Point Health-Des Moines
Lauren J. Harnois
Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center
Tyler Weiss
Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center
J. Brady Scott
Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center
Matthew W. Trump
The Iowa Clinic P.C. and Unity Point Health-Des Moines
Idrees Mogri
Pulmonary and Critical Care Medicine Division, Texas A&M School of Medicine, Baylor University Medical Center
Flor Cerda
Nursing, MICU, Rush University Medical Center
Amnah A. Alolaiwat
Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center
Amanda R. Miller
Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center
Andrew M. Klein
Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center
Trevor W. Oetting
Department of Respiratory Care, Unity Point Health-Des Moines
Lindsey Morris
Pulmonary and Critical Care Medicine Division, Texas A&M School of Medicine, Baylor University Medical Center
Scott Heckart
Department of Respiratory Care, Unity Point Health-Des Moines
Lindsay Capouch
Department of Respiratory Care, Unity Point Health-Des Moines
Hangyong He
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University
Jie Li
Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center
Abstract Background Awake prone positioning (APP) is widely used in the management of patients with coronavirus disease (COVID-19). The primary objective of this study was to compare the outcome of COVID-19 patients who received early versus late APP. Methods Post hoc analysis of data collected for a randomized controlled trial (ClinicalTrials.gov NCT04325906). Adult patients with acute hypoxemic respiratory failure secondary to COVID-19 who received APP for at least one hour were included. Early prone positioning was defined as APP initiated within 24 h of high-flow nasal cannula (HFNC) start. Primary outcomes were 28-day mortality and intubation rate. Results We included 125 patients (79 male) with a mean age of 62 years. Of them, 92 (73.6%) received early APP and 33 (26.4%) received late APP. Median time from HFNC initiation to APP was 2.25 (0.8–12.82) vs 36.35 (30.2–75.23) hours in the early and late APP group (p < 0.0001), respectively. Average APP duration was 5.07 (2.0–9.05) and 3.0 (1.09–5.64) hours per day in early and late APP group (p < 0.0001), respectively. The early APP group had lower mortality compared to the late APP group (26% vs 45%, p = 0.039), but no difference was found in intubation rate. Advanced age (OR 1.12 [95% CI 1.0–1.95], p = 0.001), intubation (OR 10.65 [95% CI 2.77–40.91], p = 0.001), longer time to initiate APP (OR 1.02 [95% CI 1.0–1.04], p = 0.047) and hydrocortisone use (OR 6.2 [95% CI 1.23–31.1], p = 0.027) were associated with increased mortality. Conclusions Early initiation (< 24 h of HFNC use) of APP in acute hypoxemic respiratory failure secondary to COVID-19 improves 28-day survival. Trial registration ClinicalTrials.gov NCT04325906.
