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Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy

Background: Patients with COVID-19 may experience hypoxemic Acute Respiratory Failure (hARF) requiring O(2)-therapy by High-Flow Nasal Cannula (HFNO). Although Prone Positioning (PP) may improve oxygenation in COVID-19 non-intubated patients, the results on its clinical efficacy are controversial. T...

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Autores principales: Vianello, Andrea, Turrin, Martina, Guarnieri, Gabriella, Molena, Beatrice, Arcaro, Giovanna, Turato, Cristian, Braccioni, Fausto, Bertagna De Marchi, Leonardo, Lionello, Federico, Subotic, Pavle, Masiero, Stefano, Giraudo, Chiara, Navalesi, Paolo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8348451/
https://www.ncbi.nlm.nih.gov/pubmed/34362185
http://dx.doi.org/10.3390/jcm10153404
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author Vianello, Andrea
Turrin, Martina
Guarnieri, Gabriella
Molena, Beatrice
Arcaro, Giovanna
Turato, Cristian
Braccioni, Fausto
Bertagna De Marchi, Leonardo
Lionello, Federico
Subotic, Pavle
Masiero, Stefano
Giraudo, Chiara
Navalesi, Paolo
author_facet Vianello, Andrea
Turrin, Martina
Guarnieri, Gabriella
Molena, Beatrice
Arcaro, Giovanna
Turato, Cristian
Braccioni, Fausto
Bertagna De Marchi, Leonardo
Lionello, Federico
Subotic, Pavle
Masiero, Stefano
Giraudo, Chiara
Navalesi, Paolo
author_sort Vianello, Andrea
collection PubMed
description Background: Patients with COVID-19 may experience hypoxemic Acute Respiratory Failure (hARF) requiring O(2)-therapy by High-Flow Nasal Cannula (HFNO). Although Prone Positioning (PP) may improve oxygenation in COVID-19 non-intubated patients, the results on its clinical efficacy are controversial. The present study aims to prospectively investigate whether PP may reduce the need for endotracheal intubation (ETI) in patients with COVID-19 receiving HFNO. Methods: All consecutive unselected adult patients with bilateral lung opacities on chest X-ray receiving HFNO after admission to a SARS-CoV-2 Respiratory Intermediate Care Unit (RICU) were considered eligible. Patients who successfully passed an initial PP trial (success group) underwent PP for periods ≥ 2 h twice a day, while receiving HFNO. The study’s primary endpoint was the intubation rate during the stay in the RICU. Results: Ninety-three patients were included in the study. PP was feasible and safe in 50 (54%) patients. Sixteen (17.2%) patients received ETI and 27 (29%) escalated respiratory support, resulting in a mortality rate of 9/93 (9.7%). The length of hospital stay was 18 (6–75) days. In 41/50 (80%) of subjects who passed the trial and underwent PP, its use was associated with clinical benefit and survival without escalation of therapy. Conclusions: PP is feasible and safe in over 50% of COVID-19 patients receiving HFNO for hARF. Randomized trials are required to confirm that PP has the potential to reduce intubation rate.
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spelling pubmed-83484512021-08-08 Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy Vianello, Andrea Turrin, Martina Guarnieri, Gabriella Molena, Beatrice Arcaro, Giovanna Turato, Cristian Braccioni, Fausto Bertagna De Marchi, Leonardo Lionello, Federico Subotic, Pavle Masiero, Stefano Giraudo, Chiara Navalesi, Paolo J Clin Med Article Background: Patients with COVID-19 may experience hypoxemic Acute Respiratory Failure (hARF) requiring O(2)-therapy by High-Flow Nasal Cannula (HFNO). Although Prone Positioning (PP) may improve oxygenation in COVID-19 non-intubated patients, the results on its clinical efficacy are controversial. The present study aims to prospectively investigate whether PP may reduce the need for endotracheal intubation (ETI) in patients with COVID-19 receiving HFNO. Methods: All consecutive unselected adult patients with bilateral lung opacities on chest X-ray receiving HFNO after admission to a SARS-CoV-2 Respiratory Intermediate Care Unit (RICU) were considered eligible. Patients who successfully passed an initial PP trial (success group) underwent PP for periods ≥ 2 h twice a day, while receiving HFNO. The study’s primary endpoint was the intubation rate during the stay in the RICU. Results: Ninety-three patients were included in the study. PP was feasible and safe in 50 (54%) patients. Sixteen (17.2%) patients received ETI and 27 (29%) escalated respiratory support, resulting in a mortality rate of 9/93 (9.7%). The length of hospital stay was 18 (6–75) days. In 41/50 (80%) of subjects who passed the trial and underwent PP, its use was associated with clinical benefit and survival without escalation of therapy. Conclusions: PP is feasible and safe in over 50% of COVID-19 patients receiving HFNO for hARF. Randomized trials are required to confirm that PP has the potential to reduce intubation rate. MDPI 2021-07-30 /pmc/articles/PMC8348451/ /pubmed/34362185 http://dx.doi.org/10.3390/jcm10153404 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Vianello, Andrea
Turrin, Martina
Guarnieri, Gabriella
Molena, Beatrice
Arcaro, Giovanna
Turato, Cristian
Braccioni, Fausto
Bertagna De Marchi, Leonardo
Lionello, Federico
Subotic, Pavle
Masiero, Stefano
Giraudo, Chiara
Navalesi, Paolo
Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy
title Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy
title_full Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy
title_fullStr Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy
title_full_unstemmed Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy
title_short Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy
title_sort prone positioning is safe and may reduce the rate of intubation in selected covid-19 patients receiving high-flow nasal oxygen therapy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8348451/
https://www.ncbi.nlm.nih.gov/pubmed/34362185
http://dx.doi.org/10.3390/jcm10153404
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