Ni Zhong, Wang Kaige, Wang Ting, Ni Yuenan, Huang Wei, Zhu Ping, Fan Tao, Wang Ye, Wang Bo, Deng Jun, Qian Zhicheng, Liu Jiasheng, Cai Wenhao, Xu Shanling, Du Yu, Wang Gang, Liang Zongan, Li Weimin, Luo Jianfei, Luo Fengming, Liu Dan
Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
Precis Clin Med. 2020 Sep 28;3(4):260-271. doi: 10.1093/pcmedi/pbaa034. eCollection 2020 Dec.
Position intervention has been shown to improve oxygenation, but its role in non-invasively ventilated patients with severe COVID-19 has not been assessed. The objective of this study was to investigate the efficacy of early position intervention on non-invasively ventilated patients with severe COVID-19.
This was a single-center, prospective observational study in consecutive patients with severe COVID-19 managed in a provisional ICU at Renmin Hospital of Wuhan University from 31 January to 15 February 2020. Patients with chest CT showing exudation or consolidation in bilateral peripheral and posterior parts of the lungs were included. Early position intervention (prone or lateral) was commenced for > 4 hours daily for 10 days in these patients, while others received standard care.
The baseline parameters were comparable between the position intervention group ( = 17) and the standard care group ( = 35). Position intervention was well-tolerated and increased cumulative adjusted mean difference of SpO/FiO (409, 95% CI 86 to 733) and ROX index (26, 95% CI 9 to 43) with decreased Borg scale (-9, 95% CI -15 to -3) during the first 7 days. It also facilitated absorption of lung lesions and reduced the proportion of patients with high National Early Warning Score 2 (≥ 7) on days 7 and 14, with a trend toward faster clinical improvement. Virus shedding and length of hospital stay were comparable between the two groups.
This study provides the first evidence for improved oxygenation and lung lesion absorption using early position intervention in non-invasively ventilated patients with severe COVID-19, and warrants further randomized trials.
体位干预已被证明可改善氧合，但尚未评估其在重度新型冠状病毒肺炎（COVID-19）无创通气患者中的作用。本研究的目的是探讨早期体位干预对重度COVID-19无创通气患者的疗效。
这是一项单中心前瞻性观察性研究，研究对象为2020年1月31日至2月15日在武汉大学人民医院临时重症监护病房接受治疗的连续性重度COVID-19患者。纳入胸部CT显示肺部双侧外周和后部有渗出或实变的患者。这些患者每天进行超过4小时的早期体位干预（俯卧位或侧卧位），持续10天，而其他患者接受标准治疗。
体位干预组（n = 17）和标准治疗组（n = 35）的基线参数具有可比性。体位干预耐受性良好，在第1个7天内，SpO₂/FiO₂的累积调整平均差值增加（409，95%可信区间86至733），ROX指数增加（26，95%可信区间9至43），Borg量表评分降低（-9，95%可信区间-15至-3）。它还促进了肺部病变的吸收，并降低了第7天和第14天国家早期预警评分2（≥7）高的患者比例，临床改善有加快的趋势。两组之间的病毒脱落情况和住院时间相当。
本研究首次提供了证据，表明早期体位干预可改善重度COVID-19无创通气患者的氧合和肺部病变吸收，值得进一步进行随机试验。
