俯卧位对接受无创氧疗的新型冠状病毒肺炎急性低氧性呼吸衰竭患者的影响。
Effect of proning in patients with COVID-19 acute hypoxemic respiratory failure receiving noninvasive oxygen therapy.
作者信息
Sryma P B, Mittal Saurabh, Mohan Anant, Madan Karan, Tiwari Pawan, Bhatnagar Sushma, Trikha Anjan, Dosi Ravi, Bhopale Shweta, Viswanath Renjith, Hadda Vijay, Guleria Randeep, Baldwa Bhvya
机构信息
Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Lung India. 2021 Mar;38(Supplement):S6-S10. doi: 10.4103/lungindia.lungindia_794_20.
BACKGROUND
Novel coronavirus (SARS-CoV-2) infection is associated with hypoxemic respiratory failure. Mechanical ventilation (MV) is reported to have high mortality in SARS-CoV-2 acute respiratory distress syndrome. We aimed to investigate whether awake prone positioning (PP) can improve oxygenation and prevent intubation when employed early.
METHODS
This prospective interventional study included proven coronavirus disease 2019 (COVID-19) patients with room air saturation 93% or less. The primary outcome was the rate of intubation between the two groups. The secondary outcomes included ROX index (SpO/FiO%/respiratory rate, breaths/min) at 30 min following the intervention, ROX index at 12 h, time to recovery of hypoxemia, and mortality.
RESULTS
A total of 45 subjects were included (30 cases and 15 controls) with a mean (standard deviation [SD]) age of 53.1 (11.0) years. The age, comorbidities, and baseline ROX index were similar between the two groups. The median duration of PP achieved was 7.5 h on the 1 day. The need for MV was higher in the control group (5/15; 33.3%) versus prone group (2/30; 6.7%). At 30 min, there was a statistically significant improvement in the mean (SD) ROX index of cases compared with that of the controls (10.7 [3.8] vs. 6.7 [2.6], P < 0.001). No significant adverse effects related to intervention were noted.
CONCLUSION
Awake PP is associated with significant improvement in oxygenation and may reduce the need for MV in subjects with COVID-19.
背景
新型冠状病毒（SARS-CoV-2）感染与低氧性呼吸衰竭相关。据报道，在SARS-CoV-2急性呼吸窘迫综合征中，机械通气（MV）的死亡率很高。我们旨在研究早期采用清醒俯卧位（PP）是否能改善氧合并预防插管。
方法
这项前瞻性干预研究纳入了经证实的2019冠状病毒病（COVID-19）患者，其室内空气饱和度为93%或更低。主要结局是两组之间的插管率。次要结局包括干预后30分钟时的ROX指数（血氧饱和度/吸入氧分数值/呼吸频率，次/分钟）、12小时时的ROX指数、低氧血症恢复时间和死亡率。
结果
共纳入45名受试者（30例病例和15例对照），平均（标准差[SD]）年龄为53.1（11.0）岁。两组之间的年龄、合并症和基线ROX指数相似。第1天达到的PP中位持续时间为7.5小时。对照组（5/15；33.3%）与俯卧位组（2/30；6.7%）相比，MV需求更高。30分钟时，病例的平均（SD）ROX指数与对照组相比有统计学显著改善（10.7[3.8]对6.7[2.6]，P<0.001）。未观察到与干预相关的显著不良反应。
结论
清醒PP与氧合的显著改善相关，可能会减少COVID-19患者对MV的需求。
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