tetano
Editor, Senior Moderator
Intensive Care Med
. 2024 Aug 1.
doi: 10.1007/s00134-024-07545-x. Online ahead of print. Prolonged vs shorter awake prone positioning for COVID-19 patients with acute respiratory failure: a multicenter, randomised controlled trial
Ling Liu[SUP] #[/SUP][SUP] 1 [/SUP], Qin Sun[SUP] #[/SUP][SUP] 1 [/SUP], Hongsheng Zhao[SUP] #[/SUP][SUP] 2 [/SUP], Weili Liu[SUP] #[/SUP][SUP] 3 [/SUP], Xuehua Pu[SUP] #[/SUP][SUP] 4 [/SUP], Jibin Han[SUP] #[/SUP][SUP] 5 [/SUP], Jiangquan Yu[SUP] 6 [/SUP], Jun Jin[SUP] 7 [/SUP], Yali Chao[SUP] 1 8 [/SUP], Sicong Wang[SUP] 9 [/SUP], Yu Liu[SUP] 10 [/SUP], Bin Wu[SUP] 11 [/SUP], Ying Zhu[SUP] 12 [/SUP], Yang Li[SUP] 1 [/SUP], Wei Chang[SUP] 1 [/SUP], Tao Chen[SUP] #[/SUP][SUP] 13 14 [/SUP], Jianfeng Xie[SUP] #[/SUP][SUP] 1 [/SUP], Yi Yang[SUP] #[/SUP][SUP] 1 [/SUP], Haibo Qiu[SUP] #[/SUP][SUP] 15 [/SUP], Arthur Slutsky[SUP] #[/SUP][SUP] 16 17 18 [/SUP]; Chi-ARDS Net (Chinese ARDS Research Network)
Collaborators, Affiliations
Purpose: Awake prone positioning has been reported to reduce endotracheal intubation in patients with coronavirus disease 2019 (COVID-19)-related acute hypoxemic respiratory failure (AHRF). However, it is still unclear whether using the awake prone positioning for longer periods can further improve outcomes.
Methods: In this randomized, open-label clinical trial conducted at 12 hospitals in China, non-intubated patients with COVID-19-related AHRF were randomly assigned to prolonged awake prone positioning (target > 12 h daily for 7 days) or standard care with a shorter period of awake prone positioning. The primary outcome was endotracheal intubation within 28 days after randomization. The key secondary outcomes included mortality and adverse events.
Results: In total, 409 patients were enrolled and randomly assigned to prolonged awake prone positioning (n = 205) or standard care (n = 204). In the first 7 days after randomization, the median duration of prone positioning was 12 h/d (interquartile range [IQR] 12-14 h/d) in the prolonged awake prone positioning group vs. 5 h/d (IQR 2-8 h/d) in the standard care group. In the intention-to-treat analysis, intubation occurred in 35 (17%) patients assigned to prolonged awake prone positioning and in 56 (27%) patients assigned to standard care (relative risk 0.62 [95% confidence interval (CI) 0.42-0.9]). The hazard ratio (HR) for intubation was 0.56 (0.37-0.86), and for mortality was 0.63 (0.42-0.96) for prolonged awake prone positioning versus standard care, within 28 days. The incidence of pre-specified adverse events was low and similar in both groups.
Conclusion: Prolonged awake prone positioning of patients with COVID-19-related AHRF reduces the intubation rate without significant harm. These results support prolonged awake prone positioning of patients with COVID-19-related AHRF.
Trial registration: ClinicalTrials.gov NCT05677984.
Keywords: COVID-19-related acute respiratory failure; Intubation; Mortality; Prolonged awake prone positioning.
. 2024 Aug 1.
doi: 10.1007/s00134-024-07545-x. Online ahead of print. Prolonged vs shorter awake prone positioning for COVID-19 patients with acute respiratory failure: a multicenter, randomised controlled trial
Ling Liu[SUP] #[/SUP][SUP] 1 [/SUP], Qin Sun[SUP] #[/SUP][SUP] 1 [/SUP], Hongsheng Zhao[SUP] #[/SUP][SUP] 2 [/SUP], Weili Liu[SUP] #[/SUP][SUP] 3 [/SUP], Xuehua Pu[SUP] #[/SUP][SUP] 4 [/SUP], Jibin Han[SUP] #[/SUP][SUP] 5 [/SUP], Jiangquan Yu[SUP] 6 [/SUP], Jun Jin[SUP] 7 [/SUP], Yali Chao[SUP] 1 8 [/SUP], Sicong Wang[SUP] 9 [/SUP], Yu Liu[SUP] 10 [/SUP], Bin Wu[SUP] 11 [/SUP], Ying Zhu[SUP] 12 [/SUP], Yang Li[SUP] 1 [/SUP], Wei Chang[SUP] 1 [/SUP], Tao Chen[SUP] #[/SUP][SUP] 13 14 [/SUP], Jianfeng Xie[SUP] #[/SUP][SUP] 1 [/SUP], Yi Yang[SUP] #[/SUP][SUP] 1 [/SUP], Haibo Qiu[SUP] #[/SUP][SUP] 15 [/SUP], Arthur Slutsky[SUP] #[/SUP][SUP] 16 17 18 [/SUP]; Chi-ARDS Net (Chinese ARDS Research Network)
Collaborators, Affiliations
- PMID: 39088076
- DOI: 10.1007/s00134-024-07545-x
Purpose: Awake prone positioning has been reported to reduce endotracheal intubation in patients with coronavirus disease 2019 (COVID-19)-related acute hypoxemic respiratory failure (AHRF). However, it is still unclear whether using the awake prone positioning for longer periods can further improve outcomes.
Methods: In this randomized, open-label clinical trial conducted at 12 hospitals in China, non-intubated patients with COVID-19-related AHRF were randomly assigned to prolonged awake prone positioning (target > 12 h daily for 7 days) or standard care with a shorter period of awake prone positioning. The primary outcome was endotracheal intubation within 28 days after randomization. The key secondary outcomes included mortality and adverse events.
Results: In total, 409 patients were enrolled and randomly assigned to prolonged awake prone positioning (n = 205) or standard care (n = 204). In the first 7 days after randomization, the median duration of prone positioning was 12 h/d (interquartile range [IQR] 12-14 h/d) in the prolonged awake prone positioning group vs. 5 h/d (IQR 2-8 h/d) in the standard care group. In the intention-to-treat analysis, intubation occurred in 35 (17%) patients assigned to prolonged awake prone positioning and in 56 (27%) patients assigned to standard care (relative risk 0.62 [95% confidence interval (CI) 0.42-0.9]). The hazard ratio (HR) for intubation was 0.56 (0.37-0.86), and for mortality was 0.63 (0.42-0.96) for prolonged awake prone positioning versus standard care, within 28 days. The incidence of pre-specified adverse events was low and similar in both groups.
Conclusion: Prolonged awake prone positioning of patients with COVID-19-related AHRF reduces the intubation rate without significant harm. These results support prolonged awake prone positioning of patients with COVID-19-related AHRF.
Trial registration: ClinicalTrials.gov NCT05677984.
Keywords: COVID-19-related acute respiratory failure; Intubation; Mortality; Prolonged awake prone positioning.