Use of Prone Positioning in Nonintubated Patients With COVID-19 and Hypoxemic Acute Respiratory Failure

Abstract

for data acquisition and informatics support. We thank the following persons affiliated with the

Awake Prone Positioning Does Not Reduce the Risk of Intubation in COVID-19 Treated with High-Flow Nasal Oxygen Therapy. A Multicenter, Adjusted Cohort Study

“…No information regarding the need for intubation was provided. 11 Thompson et al 12 in a similar population of 25 patients managed with conventional oxygen therapy found a heterogeneous response to awake-PP with improvements in SpO 2 ranging from 1-37%, but 12 patients (48%) patients required intubation. Better results were found by Ng et al 13 who applied daily awake-PP sessions of 5 hours in 10 non-ICU patients with only one needing intubation.…”

“…Other adjunctive techniques, such as awake-PP, have been widely used in combination with oxygen therapy, NIV or HFNO to correct hypoxemia and avoid the need for invasive MV. [11][12][13][14][15][16] The bene ts of prone positioning in ARDS patients have been well established. By rearrangement of the vertical transpulmonary pressure gradients, prone positioning favors lung recruitment improving V/Q mismatch by decreasing shunt.…”

“…24 Data on the use of awake-PP in COVID-19 patients is limited to small, single-center studies or case series with contradictory results. Elharrar et al 11 examined the effects of awake-PP in 24 patients receiving oxygen therapy. Oxygenation improved in about one fourth of patients, and deteriorated again after turning the patient to supine.…”

“…10 Several studies have shown that the combination of awake-PP and HFNO or non-invasive ventilation (NIV) is feasible in patients with severe COVID-19 pneumonia, resulting in an increase in oxygenation or a decrease in the respiratory rate and/or dyspnea. [11][12][13][14][15][16] However, to date, it has not been established whether the combination of HFNO plus awake-PP could prevent the need for invasive MV and decrease the need of ICU resources in COVID-19 patients with ARF. We performed this large multicenter adjusted cohort study to investigate those issues.…”

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19 

“…Firstly, although we included all consecutive patients admitted in our hospital, our study still has a moderate sample size. However, this is the case for several other studies involving critically ill patients with COVID-19 [13,18]. Also, the moderate sample size is the fortunate outcome of the early attening of the epidemiological curve in Greece and eventually the reason we were able to estimate the effect of early versus delayed or no intubation on outcomes of patients with COVID-19 without the major confounding factor of the shortage of ventilators.…”