Li WanLing, Xu Na, Wei Jia, Zhu WenJuan, Niu YanBin, Wei Jing, Mei Qi, Wang XiuMei, Wang Hui
Nursing Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030000, China; Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
Central Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030000, China.
Aust Crit Care. 2025 Mar;38(2):101105. doi: 10.1016/j.aucc.2024.08.002. Epub 2024 Sep 10.
Patients not mechanically ventilated often fail to achieve the recommended duration of awake prone positioning due to treatment interruption and discomfort. Few studies have investigated the link between treatment outcome and prone-positioning duration, the inability to accurately guide patients to perform awake prone positioning.
The aim of this study was to characterise and explore the relationship between awake prone-positioning duration with the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO/FiO [P/F]) changes and the risk of disease aggravation.
A prospective cohort study; dose-response relationship was used. Awake prone positioning was performed on patients with severe Corona Virus Disease 2019 (COVID-19) for 5 consecutive days from 1 February to 21 March 2023. Linear and logistic regression models were utilised to assess the association between prone-positioning duration with P/F changes and risk of disease aggravation, respectively. Meanwhile, the restricted cubic spline was used to evaluate the dose-response relationships.
A total of 408 patients with severe COVID-19 were analysed. The daily prone positioning duration was 4.57 ± 2.74 h/d, and the changes in P/F were 67.63 ± 69.17 mmHg. On the sixth day of hospitalisation, the condition of 52 (12.8%) patients deteriorated. There was a positive, nonlinear dose-response relationship (P < 0.001, P = 0.041) and a strong, significant positive correlation (β = 29.286, t = 4.302, P < 0.001) between the prone-positioning duration and P/F changes. The risk of disease aggravation gradually decreases with the increase of prone-positioning duration. Nonetheless, the prone-positioning duration was not statistically associated with disease aggravation (odds ratio = 0.986, 95% confidence interval: 0.514-1.895).
Awake prone positioning for ≥4 h/d is effective on oxygenation (not mortality/intubation) and is achievable for patients with severe COVID-19. Prolonged prone positioning is promising in improving patients' oxygenation but does not alleviate their risk of disease aggravation.
未接受机械通气的患者常常因治疗中断和不适而无法达到推荐的清醒俯卧位持续时间。很少有研究调查治疗结果与俯卧位持续时间之间的联系，无法准确指导患者进行清醒俯卧位。
本研究旨在描述和探讨清醒俯卧位持续时间与动脉血氧分压与吸入氧分数之比（PaO/FiO [P/F]）变化以及疾病加重风险之间的关系。
一项前瞻性队列研究；采用剂量反应关系。2023年2月1日至3月21日，对重症2019冠状病毒病（COVID-19）患者连续5天进行清醒俯卧位。分别采用线性和逻辑回归模型评估俯卧位持续时间与P/F变化以及疾病加重风险之间的关联。同时，使用受限立方样条评估剂量反应关系。
共分析了408例重症COVID-19患者。每日俯卧位持续时间为4.57±2.74小时/天，P/F变化为67.63±69.17mmHg。住院第6天，52例（12.8%）患者病情恶化。俯卧位持续时间与P/F变化之间存在正的非线性剂量反应关系（P<0.001，P=0.041）和强的、显著的正相关（β=29.286，t=4.302，P<0.001）。疾病加重风险随着俯卧位持续时间的增加而逐渐降低。尽管如此，俯卧位持续时间与疾病加重无统计学关联（比值比=0.986，95%置信区间：0.514-1.895）。
每天≥4小时的清醒俯卧位对氧合有效（而非死亡率/插管），重症COVID-19患者可以实现。延长俯卧位对改善患者氧合有前景，但不能减轻其疾病加重风险。
