Impact of exposure time in awake prone positioning on clinical outcomes of patients with COVID-19-related acute respiratory failure treated with high-flow nasal oxygen: a multicenter cohort study
Mariano Esperatti,
Marina Busico,
Nora Angélica Fuentes,
Adrian Gallardo,
Javier Osatnik,
Alejandra Vitali,
Elizabeth Gisele Wasinger,
Matías Olmos,
Jorgelina Quintana,
Santiago Nicolas Saavedra,
Ana Inés Lagazio,
Facundo Juan Andrada,
Hiromi Kakisu,
Nahuel Esteban Romano,
Agustin Matarrese,
Mariela Adriana Mogadouro,
Giuliana Mast,
Claudia Navarro Moreno,
Greta Dennise Rebaza Niquin,
Veronica Barbaresi,
Alejandro Bruhn Cruz,
Bruno Leonel Ferreyro,
Antoni Torres,
Argentine Collaborative Group on High Flow and Prone Positioning
Affiliations
Mariano Esperatti
Intensive Care Unit, Hospital Privado de Comunidad
Marina Busico
Intensive Care Unit, Clínica Olivos SMG
Nora Angélica Fuentes
Intensive Care Unit, Hospital Privado de Comunidad
Adrian Gallardo
Intensive Care Unit, Sanatorio Clínica Modelo de Morón
Javier Osatnik
Intensive Care Unit, Hospital Aleman
Alejandra Vitali
Intensive Care Unit, Sanatorio de La Trinidad Palermo
Elizabeth Gisele Wasinger
Intensive Care Unit, Hospital Universitario Austral
Matías Olmos
Intensive Care Unit, Hospital Privado de Comunidad
Jorgelina Quintana
Intensive Care Unit, Clínica Olivos SMG
Santiago Nicolas Saavedra
Intensive Care Unit, Hospital Aleman
Ana Inés Lagazio
Intensive Care Unit, Sanatorio de La Trinidad Palermo
Facundo Juan Andrada
Intensive Care Unit, Hospital Universitario Austral
Hiromi Kakisu
Intensive Care Unit, Hospital Privado de Comunidad
Nahuel Esteban Romano
Intensive Care Unit, Clínica Olivos SMG
Agustin Matarrese
Intensive Care Unit, Hospital Aleman
Mariela Adriana Mogadouro
Intensive Care Unit, Sanatorio de La Trinidad Palermo
Giuliana Mast
Intensive Care Unit, Hospital Universitario Austral
Claudia Navarro Moreno
Intensive Care Unit, Hospital Privado de Comunidad
Greta Dennise Rebaza Niquin
Intensive Care Unit, Hospital Aleman
Veronica Barbaresi
Intensive Care Unit, Hospital Privado de Comunidad
Alejandro Bruhn Cruz
Departement of Intensive Medicine, Pontificia Universidad Católica de Chile
Bruno Leonel Ferreyro
Interdepartmental Division of Critical Care Medicine, University of Toronto
Antoni Torres
Pulmonary Department, Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERES
Argentine Collaborative Group on High Flow and Prone Positioning
Abstract Background In patients with COVID-19-related acute respiratory failure (ARF), awake prone positioning (AW-PP) reduces the need for intubation in patients treated with high-flow nasal oxygen (HFNO). However, the effects of different exposure times on clinical outcomes remain unclear. We evaluated the effect of AW-PP on the risk of endotracheal intubation and in-hospital mortality in patients with COVID-19-related ARF treated with HFNO and analyzed the effects of different exposure times to AW-PP. Methods This multicenter prospective cohort study in six ICUs of 6 centers in Argentine consecutively included patients > 18 years of age with confirmed COVID-19-related ARF requiring HFNO from June 2020 to January 2021. In the primary analysis, the main exposure was awake prone positioning for at least 6 h/day, compared to non-prone positioning (NON-PP). In the sensitivity analysis, exposure was based on the number of hours receiving AW-PP. Inverse probability weighting–propensity score (IPW-PS) was used to adjust the conditional probability of treatment assignment. The primary outcome was endotracheal intubation (ETI); and the secondary outcome was hospital mortality. Results During the study period, 580 patients were screened and 335 were included; 187 (56%) tolerated AW-PP for [median (p25–75)] 12 (9–16) h/day and 148 (44%) served as controls. The IPW–propensity analysis showed standardized differences < 0.1 in all the variables assessed. After adjusting for other confounders, the OR (95% CI) for ETI in the AW-PP group was 0.36 (0.2–0.7), with a progressive reduction in OR as the exposure to AW-PP increased. The adjusted OR (95% CI) for hospital mortality in the AW-PP group ≥ 6 h/day was 0.47 (0.19–1.31). The exposure to prone positioning ≥ 8 h/d resulted in a further reduction in OR [0.37 (0.17–0.8)]. Conclusion In the study population, AW-PP for ≥ 6 h/day reduced the risk of endotracheal intubation, and exposure ≥ 8 h/d reduced the risk of hospital mortality.