Effect of early awake prone positioning application on prognosis in patients with acute respiratory failure due to COVID-19 pneumonia: a retrospective observational study

Abstract

Background We evaluated the effect of early awake prone position administration on oxygenation and intubation requirements and short-term mortality in patients with acute respiratory failure due to coronavirus disease 2019 (COVID-19) pneumonia. Methods This is an observational-cohort study. Patients receiving mask oxygen therapy in our intensive care units because of acute respiratory failure due to COVID-19 pneumonia were included. The Awake Prone Position (APP) group consisted of patients who were applied awake prone position, whereas non-APP group consisted of patients who were not applied awake prone position. PaCO 2 , PaO 2 , pH, SpO 2 values and PaO 2 /FiO 2 ratios were recorded at the beginning and 24th hour. Demographic data, comorbidities, intubation requirements, ventilator-free days, length of intensive care unit stay and short-term mortality of the patients were recorded. Results The data of total 225 patients were examined, and 48 patients who met our study criteria were included. At the 24th hour, the median SpO 2 value of the APP group was 95%, the median PaO 2 value was 82 mmHg, whereas the SpO 2 value of the non-APP group was 90% and the PaO 2 value was 66 mmHg. ( p = 0.001, p = 0.002). There was no statistically significant difference between the groups in length of intensive care unit stay and ventilator-free days, but short-term mortality and intubation requirements was lower in the APP group ( p = 0.020, p = 0.001) Conclusion Awake prone position application in patients receiving non-rebreather mask oxygen therapy for respiratory failure due to COVID-19 pneumonia improves oxygenation and decreases the intubation requirements and mortality.

Effect of Awake Prone Positioning in non-Intubated COVID-19 Patients with Acute Hypoxemic Respiratory Failure: A Systematic Review and Meta-Analysis

“…Finally, 22 studies with a total of 5146 patients were included in the meta-analysis. [21][22][23][24][25][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]…”

“…21 The other fifteen were observational studies. 23,[33][34][35][36][37][38][39][40][41][42][43][44][45][46] All the studies explored the effect of APP in COVID-19-related acute respiratory failure or ARDS patients without intubation. These patients were treated with different non-invasive respiratory support methods.…”

“…22 studies [21][22][23][24][25][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] involving 5146 patients reported intubation rates (Supplemental Figure 3). The result found that APP was associated with a significant reduction in intubation rate compared with the control group (OR 0.64; 95% CI 0.48-0.83; P = .001), with moderate heterogeneity among these studies (χ 2 = 58.62, I 2 = 66%).…”

“…Mortality 20 studies [21][22][23][24][25][30][31][32][33][34][35][36][37][38][39][40][41]43,45,46 estimated the effect of APP on mortality (Supplemental Figure 5). Pooled analysis showed that APP reduced mortality in comparison to the control group (OR 0.61; 95% CI 0.45-0.81; P = .0008), with moderate heterogeneity (χ 2 = 47.86, I 2 = 60%).…”

Two years of the COVID-19 pandemic: an anesthesiology perspective

“…For all the reasons above, in this issue of the Brazilian Journal of Anesthesiology , we invite readers to access several interesting studies providing new insights into the role of the anesthesiologist in the COVID-19 pandemic. 14 , 15 , 16 , 17 , 18 , 19 , 20 These studies have addressed a myriad of COVID-19-related topics, including the risk for environmental exposure to the SARS-CoV-2, potential protective measures to reduce contamination during airway management, mental health of healthcare providers and education concerns during the pandemic, a new technique for percutaneous tracheostomy in COVID-19 patients, and potential benefits of early awake prone positioning in patients displaying COVID-19-related ARDS.…”