Background Awake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone. Methods Prospective, multicenter, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory Sequential Organ Failure Assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate, and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP. Results A total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO + awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95% CI 0.53–1.43), p = 0.60]. Patients treated with HFNO + awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0–2.5) vs 2 IQR 1.0–3.0] days ( p = 0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95% CI 0.40–2.72), p = 0.92]. Conclusion In patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality.
【저자키워드】 COVID-19, Critical care, mechanical ventilation, Acute respiratory failure, prone positioning, High-flow nasal oxygen therapy, 【초록키워드】 Treatment, coronavirus disease, therapy, Respiratory failure, Mortality, obesity, 28-day mortality, Non-intubated, High-flow nasal oxygen, intubation, Sex, C-reactive protein, risk, ICU, Laboratory, survival, Prospective, Patient, age, vital signs, multicenter, assessment, group, predict, Combination, Invasive mechanical ventilation, Respiratory Support, COVID-19 patient, respiratory rate, Endotracheal intubation, demographics, Observational cohort study, interquartile range, Intubated, HFNO, 95% CI, failure, symptoms onset, oxyhemoglobin saturation, resources, Affect, Prevent, IMPROVE, Result, analyzed, receiving, treated, adjusted, not affect, reduce, did not reduce, ARF, baseline, delay in intubation, IQR, patients with COVID-19, 【제목키워드】 High-flow nasal oxygen, intubation, risk, cohort study, multicenter, treated, adjusted, not reduce,