Abstract
Background: The awake prone positioning strategy for patients with acute respiratory distress syndrome is a safe, simple and cost-effective technique used to improve hypoxaemia. We aimed to evaluate intubation and mortality risk in patients with coronavirus disease 2019 (COVID-19) who underwent awake prone positioning during hospitalisation.
Methods: In this retrospective, multicentre observational study conducted between 1 May 2020 and 12 June 2020 in 27 hospitals in Mexico and Ecuador, nonintubated patients with COVID-19 managed with awake prone or awake supine positioning were included to evaluate intubation and mortality risk through logistic regression models; multivariable and centre adjustment, propensity score analyses, and E-values were calculated to limit confounding.
Results: 827 nonintubated patients with COVID-19 in the awake prone (n=505) and awake supine (n=322) groups were included for analysis. Fewer patients in the awake prone group required endotracheal intubation (23.6% versus 40.4%) or died (19.8% versus 37.3%). Awake prone positioning was a protective factor for intubation even after multivariable adjustment (OR 0.35, 95% CI 0.24-0.52; p<0.0001, E=2.12), which prevailed after propensity score analysis (OR 0.41, 95% CI 0.27-0.62; p<0.0001, E=1.86) and mortality (adjusted OR 0.38, 95% CI 0.26-0.55; p<0.0001, E=2.03). The main variables associated with intubation among awake prone patients were increasing age, lower baseline peripheral arterial oxygen saturation/inspiratory oxygen fraction ratio ( P aO 2 / F IO 2 ) and management with a nonrebreather mask.
Conclusions: Awake prone positioning in hospitalised nonintubated patients with COVID-19 is associated with a lower risk of intubation and mortality.
Trial registration: ClinicalTrials.gov NCT04407468 .
【초록키워드】 COVID-19, coronavirus disease, Mortality, hospital, Awake prone positioning, intubation, oxygen, management, Patient, Logistic regression, hypoxaemia, multicentre, Ecuador, group, hospitalisation, acute respiratory distress, retrospective, mortality risk, Analysis, Safe, prone positioning, Endotracheal intubation, 95% CI, syndrome, lower risk, protective factor, increasing age, prone group, fraction, propensity score analysis, variable, hospitalised, limit, multivariable, IMPROVE, evaluate, died, required, conducted, calculated, adjusted, analyses, baseline, Fewer patient, patients with COVID-19, 【제목키워드】 Patient, Oxygen therapy, prone positioning,