Orlando R Perez-Nieto, Diego Escarraman-Martinez, Manuel A Guerrero-Gutierrez, Eder I Zamarron-Lopez, Javier Mancilla-Galindo, Ashuin Kammar-García, Miguel A Martinez-Camacho, Ernesto Deloya-Tomás, Jesús S Sanchez-Díaz, Luis A Macías-García, Raúl Soriano-Orozco, Gabriel Cruz-Sánchez, José D Salmeron-Gonzalez, Marco A Toledo-Rivera, Ivette Mata-Maqueda, Luis A Morgado-Villaseñor, Jenner J Martinez-Mazariegos, Raymundo Flores Ramirez, Josue L Medina-Estrada, Silvio A Ñamendys-Silva
Journal: The European respiratory journal 2022;59(2):2100265
PMID: 34266942
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% 40.4%) or died (19.8% 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 ( / ) 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.
Copyright ©The authors 2022.
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