COVID-19 非插管患者早期与晚期清醒俯卧位。
Early versus late awake prone positioning in non-intubated patients with COVID-19.
机构信息
Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 600 S Paulina St, Suite 765, Chicago, IL, USA.
Division of Pulmonary, Critical Care, and Sleep Medicine, Rush University Medical Center, Chicago, IL, USA.
出版信息
Crit Care. 2021 Sep 17;25(1):340. doi: 10.1186/s13054-021-03761-9.
BACKGROUND
Awake prone positioning (APP) is widely used in the management of patients with coronavirus disease (COVID-19). The primary objective of this study was to compare the outcome of COVID-19 patients who received early versus late APP.
METHODS
Post hoc analysis of data collected for a randomized controlled trial (ClinicalTrials.gov NCT04325906). Adult patients with acute hypoxemic respiratory failure secondary to COVID-19 who received APP for at least one hour were included. Early prone positioning was defined as APP initiated within 24 h of high-flow nasal cannula (HFNC) start. Primary outcomes were 28-day mortality and intubation rate.
RESULTS
We included 125 patients (79 male) with a mean age of 62 years. Of them, 92 (73.6%) received early APP and 33 (26.4%) received late APP. Median time from HFNC initiation to APP was 2.25 (0.8-12.82) vs 36.35 (30.2-75.23) hours in the early and late APP group (p < 0.0001), respectively. Average APP duration was 5.07 (2.0-9.05) and 3.0 (1.09-5.64) hours per day in early and late APP group (p < 0.0001), respectively. The early APP group had lower mortality compared to the late APP group (26% vs 45%, p = 0.039), but no difference was found in intubation rate. Advanced age (OR 1.12 [95% CI 1.0-1.95], p = 0.001), intubation (OR 10.65 [95% CI 2.77-40.91], p = 0.001), longer time to initiate APP (OR 1.02 [95% CI 1.0-1.04], p = 0.047) and hydrocortisone use (OR 6.2 [95% CI 1.23-31.1], p = 0.027) were associated with increased mortality.
CONCLUSIONS
Early initiation (< 24 h of HFNC use) of APP in acute hypoxemic respiratory failure secondary to COVID-19 improves 28-day survival. Trial registration ClinicalTrials.gov NCT04325906.
背景
清醒俯卧位（APP）在冠状病毒病（COVID-19）患者的管理中被广泛应用。本研究的主要目的是比较接受早期 APP 和晚期 APP 的 COVID-19 患者的结局。
方法
对一项随机对照试验（ClinicalTrials.gov NCT04325906）的数据进行了事后分析。纳入了接受 APP 治疗至少 1 小时的急性低氧性呼吸衰竭继发于 COVID-19 的成年患者。早期俯卧位定义为在高流量鼻导管（HFNC）开始后 24 小时内开始 APP。主要结局为 28 天死亡率和插管率。
结果
我们纳入了 125 名（79 名男性）平均年龄为 62 岁的患者。其中，92 名（73.6%）接受了早期 APP，33 名（26.4%）接受了晚期 APP。早期 APP 组从 HFNC 开始到 APP 的中位时间为 2.25（0.8-12.82）小时，而晚期 APP 组为 36.35（30.2-75.23）小时（p<0.0001）。早期 APP 组的 APP 平均持续时间为 5.07（2.0-9.05）小时/天，晚期 APP 组为 3.0（1.09-5.64）小时/天（p<0.0001）。与晚期 APP 组相比，早期 APP 组的死亡率较低（26%比 45%，p=0.039），但插管率无差异。高龄（OR 1.12 [95%CI 1.0-1.95]，p=0.001）、插管（OR 10.65 [95%CI 2.77-40.91]，p=0.001）、APP 开始时间延长（OR 1.02 [95%CI 1.0-1.04]，p=0.047）和使用氢化可的松（OR 6.2 [95%CI 1.23-31.1]，p=0.027）与死亡率增加相关。
结论
急性低氧性呼吸衰竭继发于 COVID-19 的患者中，早期（HFNC 使用<24 小时）开始 APP 可提高 28 天生存率。试验注册 ClinicalTrials.gov NCT04325906。
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