清醒俯卧位对2019冠状病毒病重症患者的疗效：一项倾向评分调整队列研究。

Efficacy of awake prone positioning for severe illness coronavirus disease 2019 patients: a propensity score-adjusted cohort study.

作者信息

Numata Kenji, Kobayashi Daiki, Hosoda Tomohiro, Saito Yutaka, Minoura Ayu, Yamazaki Satsuki, Fujitani Shigeki

机构信息

Department of Emergency and Critical Care Medicine St Marianna University School of Medicine Kawasaki Japan.

Division of General Internal Medicine St Luke's International Hospital Tokyo Japan.

出版信息

Acute Med Surg. 2022 Feb 12;9(1):e734. doi: 10.1002/ams2.734. eCollection 2022 Jan-Dec.

DOI:10.1002/ams2.734

PMID:35169487

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8840898/

Abstract

AIM

Awake prone positioning (PP) in patients with coronavirus disease 2019 (COVID-19) can improve oxygenation. However, evidence showing that it can prevent intubation is lacking. This study investigated the efficacy of awake PP in patients with COVID-19 who received remdesivir, dexamethasone, and anticoagulant therapy.

METHODS

This was a two-center cohort study. Patients admitted to the severe COVID-19 patient unit were included. The primary outcome was the intubation rate and secondary outcome was length of stay in the severe COVID-19 unit. After propensity score adjustment, we undertook multivariable regression to calculate the estimates of outcomes between patients who received awake PP and those who did not.

RESULTS

Overall, 108 patients were included (54 [50.0%] patients each who did and did not undergo awake PP), of whom 25 (23.2%) were intubated (with awake PP, 5 [9.3%] vs. without awake PP, 20 [37.0%]; < 0.01). The median length of stay in the severe COVID-19 unit did not significantly differ (with awake PP, 5 days vs. without awake PP, 5.5 days; = 0.68). After propensity score adjustment, those who received awake PP had a lower intubation rate than those who did not (odds ratio, 0.22; 95% confidence interval, 0.06-0.85; = 0.03). Length of stay in the severe COVID-19 patient unit did not differ significantly (adjusted percentage difference, -24.4%; 95% confidence interval, -56.3% to 30.8%; = 0.32).

CONCLUSION

Awake PP could be correlated with intubation rate in patients with COVID-19 who are receiving remdesivir, dexamethasone, and anticoagulant therapy.

摘要

目的

2019冠状病毒病（COVID-19）患者清醒俯卧位通气（PP）可改善氧合。然而，缺乏其能预防气管插管的证据。本研究调查了接受瑞德西韦、地塞米松和抗凝治疗的COVID-19患者清醒PP的疗效。

方法

这是一项双中心队列研究。纳入收治到重症COVID-19病房的患者。主要结局是气管插管率，次要结局是在重症COVID-19病房的住院时间。在倾向评分调整后，我们进行多变量回归以计算接受清醒PP和未接受清醒PP患者的结局估计值。

结果

总体而言，纳入108例患者（接受和未接受清醒PP的患者各54例[50.0%]），其中25例（23.2%）接受了气管插管（接受清醒PP的患者中为5例[9.3%]，未接受清醒PP的患者中为20例[37.0%]；P<0.01）。在重症COVID-19病房的中位住院时间无显著差异（接受清醒PP的患者为5天，未接受清醒PP的患者为5.5天；P=0.68）。倾向评分调整后，接受清醒PP的患者气管插管率低于未接受清醒PP的患者（比值比，0.22；95%置信区间，0.06-0.85；P=0.03）。在重症COVID-19病房的住院时间无显著差异（调整后的百分比差异，-24.4%；95%置信区间，-56.3%至30.8%；P=0.32）。