Abstract
Purpose: Studies performed in spontaneously breathing patients with mild to moderate respiratory failure suggested that prone position (PP) in COVID-19 could be beneficial.
Materials and methods: Consecutive critically ill patients with COVID-19 were enrolled in four ICUs. PP sessions lasted at least 3 h each and were performed twice daily. A Cox proportional hazard model identified factors associated with the need of intubation. A propensity score overlap weighting analysis was performed to assess the association between spontaneous breathing PP (SBPP) and intubation.
Results: Among 379 patients, 40 underwent SBPP. Oxygenation was achieved by high flow nasal canula in all but three patients. Duration of proning was 2.5 [1.6;3.4] days. SBPP was well tolerated hemodynamically, increased PaO 2 /FiO 2 (78 [68;96] versus 63 [53;77] mm Hg, p = 0.004) and PaCO 2 (38 [34;43] versus 35 [32;38] mm Hg, p = 0.005). Neither day-28 survival (HR 0.51, 95% CI 0.16-1.16] nor risk of invasive ventilation [sHR 0.96; 95% CI 0.49;1.88] differed between patients who underwent PP and others.
Conclusions: SBPP in COVID-19 is feasible and well tolerated in severely hypoxemic patients. It did not induce any effect on risk of intubation and day-28 mortality.
Keywords: COVID-19; High-flow nasal cannula; Mechanical ventilation; Prone position.
【저자키워드】 COVID-19, Prone position, mechanical ventilation, High-flow nasal cannula, 【초록키워드】 Prone position, Respiratory failure, Mortality, prone, intubation, risk, nasal, invasive ventilation, Duration, survival, Patient, Mild, moderate, patients, association, Analysis, Critically ill patient, Factor, overlap, 95% CI, ICUs, material, proning, hypoxemic, Weighting, enrolled, performed, was performed, suggested, induce, feasible, Mechanical, PaO, with COVID-19, 【제목키워드】 Prone position, Respiratory failure, Non-intubated, ICU, Impact, Patient,