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Comparative Study
. 2024 Oct 21:36:e20240065en.
doi: 10.62675/2965-2774.20240065-en. eCollection 2024.

Comparison of the effectiveness of awake-prone positioning and high-flow nasal oxygen in patients with COVID-19-related acute respiratory failure between different waves

[Article in English, Portuguese]
Mariano Esperatti  1 , Matías Olmos  1 , Marina Busico  2 , Adrian Gallardo  3 , Alejandra Vitali  4 , Jorgelina Quintana  2 , Hiromi Kakisu  1 , Bruno Leonel Ferreyro  5 , Nora Angélica Fuentes  1 ; Argentine Collaborative Group on High Flow and Prone Positioning; Javier Osatnik  6 , Santiago Nicolas Saavedra  6 , Agustin Matarrese  6 , Greta Dennise Rebaza Niquin  6 , Elizabeth Gisele Wasinger  7 , Giuliana Mast  7 , Facundo Juan Andrada  7 , Ana Inés Lagazio  8 , Nahuel Esteban Romano  8 , Marisol Mariela Laiz  8 , Jose Garcia Urrutia  8 , Mariela Adriana Mogaadouro  4 , Micaela Ruiz Seifert  4 , Emilce Mastroberti  4 , Claudia Navarro Moreno  9 , Anabel Miranda Tirado  9 , María Constanza Viñas  9 , Juan Manuel Pintos  9 , Maria Eugenia Gonzalez  9 , Maite Mateos  9 , Verónica Barbaresi  9 , Ana Elizabeth Grimbeek  9 , Leonel Stein  9 , Ariel Juan Latronico  9 , Silvia Laura Menéndez  9 , Alejandra Dominga Basualdo  9 , Romina Castrillo  9
Affiliations
Comparative Study

Comparison of the effectiveness of awake-prone positioning and high-flow nasal oxygen in patients with COVID-19-related acute respiratory failure between different waves

[Article in English, Portuguese]
Mariano Esperatti et al. Crit Care Sci. .

Abstract
in English, Portuguese

Objective: To compare the effectiveness of the awake-prone position on relevant clinical outcomes in patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen between different waves in Argentina.

Methods: This multicenter, prospective cohort study included adult patients with COVID-19-related acute respiratory failure requiring high-flow nasal oxygen. The main exposure position was the awake-prone position (≥ 6 hours/day) compared to the non-prone position. The primary outcome was endotracheal intubation, and the secondary outcome was in-hospital mortality. The inverse probability weighting-propensity score was used to adjust the conditional probability of treatment assignment. We then adjusted for contextual variables that varied over time and compared the effectiveness between the first and second waves.

Results: A total of 728 patients were included: 360 during the first wave and 368 during the second wave, of whom 195 (54%) and 227 (62%) remained awake-prone for a median (p25 - 75) of 12 (10 - 16) and 14 (8 - 17) hours/day, respectively (Awake-Prone Position Group). The ORs (95%CIs) for endotracheal intubation in the Awake-Prone Position Group were 0.25 (0.13 - 0.46) and 0.19 (0.09 - 0.31) for the first and second waves, respectively (p = 0.41 for comparison between waves). The ORs for in-hospital mortality in the awake-prone position were 0.35 (0.17 - 0.65) and 0.22 (0.12 - 0.43), respectively (p = 0.44 for comparison between waves).

Conclusion: The awake-prone position was associated with a reduction in the risk of endotracheal intubation and in-hospital mortality. These effects were independent of the context in which the intervention was applied, and no differences were observed between the different waves.

Objetivo:: Comparar a eficácia da posição prona consciente nos desfechos clínicos relevantes em pacientes com insuficiência respiratória aguda relacionada à COVID-19 que necessitaram de oxigênio nasal de alto fluxo em diferentes ondas da doença na Argentina.

Métodos:: Trata-se de estudo de coorte prospectivo e multicêntrico, que incluiu pacientes adultos com insuficiência respiratória aguda relacionada à COVID-19 que necessitaram de oxigênio nasal de alto fluxo. A principal posição de exposição foi a prona consciente (≥ 6 horas/dia) em comparação com a prona não consciente. O desfecho primário foi a intubação endotraqueal, e o secundário foi a mortalidade hospitalar. Utilizou-se o escore de propensão de ponderação pela probabilidade inversa para ajustar a probabilidade condicional de atribuição de tratamento. Em seguida, ajustamos as variáveis contextuais, que variaram ao longo do tempo e comparamos a eficácia entre a primeira e a segunda onda.

Resultados:: Ao todo, 728 pacientes foram incluídos: 360 durante a primeira onda e 368 durante a segunda onda, dos quais 195 (54%) e 227 (62%) permaneceram em prona consciente numa mediana (intervalo interquatil 25 - 75%) de 12 (10 - 16) e 14 (8 - 17) horas/dia, respectivamente (Grupo Prona Consciente). As razões de chance (intervalo de confiança de 95%) de intubação endotraqueal no grupo prona em vigília foram de 0,25 (0,13 - 0,46) e 0,19 (0,09 - 0,31) na primeira e segunda ondas, respectivamente (p = 0,41 comparativamente entre as ondas). As razões de chance de mortalidade intra-hospitalar na posição prona consciente foram de 0,35 (0,17 - 0,65) e 0,22 (0,12 - 0,43), respectivamente (p = 0,44 comparativamente entre as ondas).

Conclusão:: A posição prona consciente foi associada à redução no risco de intubação endotraqueal e mortalidade hospitalar. Esses efeitos foram independentes do contexto em que a intervenção foi aplicada e não foram observadas diferenças entre as diferentes ondas.

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Conflict of interest statement

Conflicts of interest: Marina Busico received lecture fees from Tecme S.A. and MEDIX Medical Devices S.R.L., Argentina. Marina Busico, Adrian Gallardo, Alejandra Vitali and Hiromi Kakisu reports financial support provided by Salud Investiga Grant, Ministry of Health of the Nation, Argentina. The rest of the authors declare to have no competing interests.

Figures

Figure 1
Figure 1. Patient inclusion.
Figure 2
Figure 2. Risk of intubation and in-hospital mortality between groups in the awake prone position and non-prone position during the 1st and 2nd waves in Argentina.
Figura 1
Figura 1. Inclusão de pacientes.
Figura 2
Figura 2. Risco de intubação e mortalidade intra-hospitalar nos grupos em posição prona em vigília e em posição não prona durante a primeira e a segunda ondas da COVID-19 na Argentina.
See this image and copyright information in PMC

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