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Zhang W, He Y, Gu Q, Zhang Y, Zha Q, Feng Q, Zhang S, He Y, Kang L, Xue M, Jing F, Li J, Mao Y, Zhu W. Optimal timing for awake prone positioning in Covid-19 patients: Insights from an observational study from two centers. Int J Nurs Stud 2024; 152:104707. [PMID: 38368846 DOI: 10.1016/j.ijnurstu.2024.104707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The widespread application and interest in awake prone positioning stems from its ease and availability and its ability to enhance patients' oxygenation. Nevertheless, due to the absence of consensus over the regimen of awake prone positioning, the efficacy of awake prone positioning remains uncertain. OBJECTIVE To explore the optimal regimen for awake prone positioning, including the timing of initiation, ideal daily duration, and strategies for improving patient comfort and encouraging adherence. DESIGN Retrospective observational study. SETTING(S) Two university-affiliated hospitals in Shanghai. PARTICIPANTS Between December 2022 and February 2023, a total of 475 patients with COVID-19-related pneumonia who received awake prone positioning were observed. METHODS The data were collected from the hospital's electronic medical record system. The differentiation efficiency of peripheral blood oxygen saturation [SpO2]:fractional oxygen concentration in inspired air [FiO2] ratio at first awake prone positioning for different outcomes was tested by the area under the receiver operating characteristic curve. The Cox proportional hazard regression model was used to analyze the relationship between time to occurrence of 28-day outcomes and collected variables. Kaplan-Meier curves were plotted with the percentage of 28-day outcomes according to the SpO2:FiO2 ratio at first awake prone positioning after controlling covariates through Cox regression. RESULTS The best efficiency in predicting patient outcomes was achieved when the cutoff SpO2:FiO2 ratio at first awake prone positioning was 200. Patients with a reduced SpO2:FiO2 ratio (≤200) experienced more adverse respiratory outcomes (RR = 5.42, 95%CI [3.35, 8.76], p < 0·001) and higher mortality (RR = 16.64, 95%CI [5.53, 50.13], p < 0.001). Patients with a SpO2:FiO2 ratio of ≥200 at first awake prone positioning, longer duration between first awake prone positioning and admission, more awake prone positioning days, and better awake prone positioning completion were significantly protected from 28-day adverse respiratory outcomes and mortality. CONCLUSIONS Initiating awake prone positioning with a SpO2:FiO2 ratio exceeding 200, increasing the number of awake prone positioning days, prolonging the time between first awake prone positioning and admission, and achieving better completion of awake prone positioning were found to be significantly associated with reduced adverse respiratory outcomes and mortality. REGISTRATION ClinicalTrials.gov; No.: NCT05795751; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Weiqing Zhang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Yan He
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Shanghai, China
| | - Qiuying Gu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yin Zhang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinghua Zha
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Feng
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiyu Zhang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang He
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Kang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Xue
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Jing
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinling Li
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Shanghai, China
| | - Yanjun Mao
- Department of Nursing, Shanghai Pulmonary Hospital, Shanghai, China.
| | - Weiyi Zhu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Luján M, Sayas J. When hope meets reality: the challenges of awake proning in unmonitored settings. J Thorac Dis 2024; 16:810-815. [PMID: 38410573 PMCID: PMC10894434 DOI: 10.21037/jtd-23-1588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/24/2023] [Indexed: 02/28/2024]
Affiliation(s)
- Manel Luján
- Servei de Pneumologia, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigacion Biomédica en Red (CIBERES), Madrid, Spain
| | - Javier Sayas
- Pulmonology Service, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
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Pavlov I, Li J, Kharat A, Luo J, Ibarra-Estrada M, Perez Y, McNicolas B, Poole D, Roca O, Vines D, Tavernier E, Allen T, Shyamsundar M, Ehrmann S, Simpson SQ, Guérin C, Laffey JG. Awake prone positioning in acute hypoxaemic respiratory failure: An international expert guidance. J Crit Care 2023; 78:154401. [PMID: 37639921 DOI: 10.1016/j.jcrc.2023.154401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/12/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Awake prone positioning (APP) of non-intubated patients with acute hypoxaemic respiratory failure (AHRF) has been inconsistently adopted into routine care of patients with COVID-19, likely due to apparent conflicting evidence from recent trials. This short guideline aims to provide evidence-based recommendations for the use of APP in various clinical scenarios. METHODS An international multidisciplinary panel, assembled for their expertise and representativeness, and supported by a methodologist, performed a systematic literature search, summarized the available evidence derived from randomized clinical trials, and developed recommendations using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. RESULTS The panel strongly recommends that APP rather than standard supine care be used in patients with COVID-19 receiving advanced respiratory support (high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation). Due to lack of evidence from randomized controlled trials, the panel provides no recommendation on the use of APP in patients with COVID-19 supported with conventional oxygen therapy, nor in patients with AHRF due to causes other than COVID-19. CONCLUSION APP should be routinely implemented in patients with COVID-19 receiving advanced respiratory support.
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Affiliation(s)
- Ivan Pavlov
- Department of Emergency Medicine, Hôpital de Verdun, Montréal, Québec, Canada
| | - Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
| | - Aileen Kharat
- Department of Respiratory Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Jian Luo
- Respiratory Medicine Unit and Oxford NIHR Biomedical Research Centre, NDM Experimental Medicine, University of Oxford, Oxford, UK
| | - Miguel Ibarra-Estrada
- Unidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Yonatan Perez
- Médecine Intensive Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Bairbre McNicolas
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals and School of Medicine, University of Galway, Galway, Ireland
| | - Daniele Poole
- Operative Unit of Anesthesia and Intensive Care, S. Martino Hospital, Belluno, Italy
| | - Oriol Roca
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Parc del Taulí 1, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Vines
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
| | - Elsa Tavernier
- Methods in Patient-Centered Outcomes and Health Research, INSERM UMR 1246, Nantes, France; Clinical Investigation Centre, INSERM 1415 CHRU Tours, Tours, France
| | - Thérèse Allen
- Retired Nurse, and Patient Representative, Galway, Ireland
| | - Murali Shyamsundar
- Wellcome-Wolfson Institute For Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, Clinical Investigation Center, INSERM 1415, INSERM, Centre d'Etude des Pathologies Respiratoires, Université de Tours - All in Tours, U1100, France
| | | | - Claude Guérin
- Université de Lyon, Lyon, France; Institut Mondor de Recherches Biomédicales, INSERM 955 CNRS, 7200, Créteil, France
| | - John G Laffey
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals and School of Medicine, University of Galway, Galway, Ireland.
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Al Duhailib Z, Parhar KKS, Solverson K, Alhazzani W, Weatherald J. Awake prone position in patients with acute hypoxic respiratory failure: A narrative review. Respir Med Res 2023; 84:101037. [PMID: 37625375 DOI: 10.1016/j.resmer.2023.101037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/03/2023] [Accepted: 06/19/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Zainab Al Duhailib
- Critical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Canada; O'Brien Institute for Public Health and Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Kevin Solverson
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Canada; Department of Medicine, Division of Respirology, University of Calgary, Calgary, Canada
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada; Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jason Weatherald
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada.
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Li J, Ibarra-Estrada M, Guérin C. Prone Positioning for Patients With COVID-19-Induced Acute Hypoxemic Respiratory Failure: Flipping the Script. Respir Care 2023; 68:1449-1464. [PMID: 37722733 PMCID: PMC10506644 DOI: 10.4187/respcare.11227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
During the COVID-19 pandemic, prone positioning (PP) emerged as a widely used supportive therapy for patients with acute hypoxemic respiratory failure caused by COVID-19 infection. In particular, awake PP (APP)-the placement of non-intubated patients in the prone position-has gained popularity and hence is detailed first herein. This review discusses recent publications on the use of PP for non-intubated and intubated subjects with COVID-19, highlighting the physiological responses, clinical outcomes, influential factors affecting treatment success, and strategies to improve adherence with APP. The use of prolonged PP and the use of PP for patients undergoing extracorporeal membrane oxygenation are also presented.
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Affiliation(s)
- Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, Illinois.
| | - Miguel Ibarra-Estrada
- Unidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde Guadalajara, Universidad de Guadalajara, Jalisco, México; Grupo Internacional de Ventilación Mecánica WeVent; and Latin American Intensive Care Network (LIVEN)
| | - Claude Guérin
- Médecine Intensive Réanimation, Hôpital Édouard Herriot, Lyon, France; Université de Lyon, Lyon, France; and Institut Mondor de Recherches Biomédicales, INSERM 955 CNRS 7000, Créteil, France
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6
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Zhu L, Ni Z, Zhang Y, Zhan Y, Lan M, Zhao R. Barriers and facilitators of adherence to awake prone positioning: a qualitative study using the COM-B model. BMC Pulm Med 2023; 23:267. [PMID: 37468848 DOI: 10.1186/s12890-023-02561-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Awake prone positioning (APP) is a recommended therapy for non-intubated ARDS patients, but adherence can be challenging. Understanding the barriers and facilitators of adherence to APP is essential to increase the adherence of therapy and improve patient outcomes. The objective of this study was to explore the barriers and facilitators of adherence to awake prone ventilation using a qualitative approach and the Capability, Opportunity, Motivation-Behavior (COM-B) model. METHODS Semi-structured, in-depth interviews were conducted with patients involved in awake prone ventilation. Data were analyzed using an adapted inductive thematical approach and mapped onto the COM-B model to identify barriers and facilitators to adherence of APP. RESULTS Nineteen patients were interviewed (aged 55-92 years). Fifteen themes were identified and mapped directly on to the six COM-B constructs, with "physical challenges" related to physical capability being the primary barrier. These COM-B sub-items reflected five other barriers, including low self-efficacy(M), treatment environment(O), availability of time(O), misconceptions about the treatment(C), and insufficient knowledge(C). Key facilitators in adhering to APP were ability to identify and overcome obstacles(C), availability and affordability of treatment(O), family influences(O), beliefs and trust in treatment(M), fear about the disease(M), and perceived benefits(M). In addition, three factors played the role of both facilitator and barrier, such as media influences(O), healthcare influences(O), and behavioral habits(M). CONCLUSION The COM-B model was proved to be a useful framework for identifying the barriers and facilitators of adherence to awake prone ventilation. The findings suggest that adherence behavior is a dynamic and balanced process and interventions aimed at improving adherence to APP should address the barriers related to capability, opportunity, and motivation. Healthcare providers should focus on providing proper guidance and training, creating a comfortable environment, and offering social support to improve patients' capability and opportunity. Additionally, promoting patients' positive beliefs and attitudes towards the treatment and addressing misconceptions and fears can further enhance patients' motivation to adhere to the treatment plan.
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Affiliation(s)
- Lingli Zhu
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jiefang road, Hangzhou, 310009, China
- Department of Nursing, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zijun Ni
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jiefang road, Hangzhou, 310009, China
- Department of Nursing, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jiefang road, Hangzhou, 310009, China
| | - Yang Zhan
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jiefang road, Hangzhou, 310009, China
- Department of Nursing, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meijuan Lan
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jiefang road, Hangzhou, 310009, China
| | - Ruiyi Zhao
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, No.88 Jiefang road, Hangzhou, 310009, China.
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McNicholas BA, Ibarra-Estrada M, Perez Y, Li J, Pavlov I, Kharat A, Vines DL, Roca O, Cosgrave D, Guerin C, Ehrmann S, Laffey JG. Awake prone positioning in acute hypoxaemic respiratory failure. Eur Respir Rev 2023; 32:32/168/220245. [PMID: 37137508 PMCID: PMC10155045 DOI: 10.1183/16000617.0245-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/22/2023] [Indexed: 05/05/2023] Open
Abstract
Awake prone positioning (APP) of patients with acute hypoxaemic respiratory failure gained considerable attention during the early phases of the coronavirus disease 2019 (COVID-19) pandemic. Prior to the pandemic, reports of APP were limited to case series in patients with influenza and in immunocompromised patients, with encouraging results in terms of tolerance and oxygenation improvement. Prone positioning of awake patients with acute hypoxaemic respiratory failure appears to result in many of the same physiological changes improving oxygenation seen in invasively ventilated patients with moderate-severe acute respiratory distress syndrome. A number of randomised controlled studies published on patients with varying severity of COVID-19 have reported apparently contrasting outcomes. However, there is consistent evidence that more hypoxaemic patients requiring advanced respiratory support, who are managed in higher care environments and who can be prone for several hours, benefit most from APP use. We review the physiological basis by which prone positioning results in changes in lung mechanics and gas exchange and summarise the latest evidence base for APP primarily in COVID-19. We examine the key factors that influence the success of APP, the optimal target populations for APP and the key unknowns that will shape future research.
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Affiliation(s)
- Bairbre A McNicholas
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital, Saolta Hospital Group, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Miguel Ibarra-Estrada
- Unidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - Yonatan Perez
- Clinical Investigation Center, INSERM 1415, CHRU Tours, Tours, France
- Médecine Intensive Réanimation, CHRU Tours, Tours, France
- Médecine Intensive Réanimation, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
| | - Ivan Pavlov
- Department of Emergency Medicine, Hôpital de Verdun, Montréal, QC, Canada
| | - Aileen Kharat
- Department of Respiratory Medicine, Geneva University Hospital, Geneva, Switzerland
| | - David L Vines
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
| | - Oriol Roca
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Cosgrave
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital, Saolta Hospital Group, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Claude Guerin
- University of Lyon, Lyon and INSERM 955, Créteil, France
| | - Stephan Ehrmann
- Clinical Investigation Center, INSERM 1415, CHRU Tours, Tours, France
- Médecine Intensive Réanimation, CHRU Tours, Tours, France
| | - John G Laffey
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital, Saolta Hospital Group, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
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Cao W, He N, Luo Y, Zhang Z. Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxic respiratory failure: a systematic review based on eight high-quality randomized controlled trials. BMC Infect Dis 2023; 23:415. [PMID: 37337193 PMCID: PMC10278266 DOI: 10.1186/s12879-023-08393-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/09/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Awake prone positioning has been widely used in non-intubated patients with acute hypoxic respiratory failure (AHRF) due to COVID-19, but the evidence is mostly from observational studies and low-quality randomized controlled trials (RCTs), with conflicting results from published studies. A systematic review of published high-quality RCTs to resolve the controversy over the efficacy and safety of awake prone positioning in non-intubated patients with AHRF due to COVID-19. METHODS Candidate studies were identified through searches of PubMed, Web of Science, Cochrane, Embase, Scopus databases from December 1, 2019 to November 1, 2022. Literature screening, data extraction and risk of bias assessment were independently conducted by two researchers. RESULTS Eight RCTs involving 2657 patients were included. Meta-analysis of fixed effects models showed that awake prone positioning did not increase mortality(OR = 0.88, 95%CI [0.72, 1.08]), length of stay in ICU (WMD = 1.14, 95%CI [-0.45, 2.72]), total length of stay (WMD = 0.11, 95%CI [-1.02, 1.23]), or incidence of adverse events (OR = 1.02, 95%CI [0.79, 1.31]) compared with usual care, but significantly reduced the intubation rate (OR = 0.72, 95%CI [0.60, 0.86]). Similar results were found in a subgroup analysis of patients who received only high flow nasal cannula (Mortality: OR = 0.86, 95%CI [0.70, 1.05]; Intubation rate: OR = 0.69, 95%CI [0.58, 0.83]). All eight RCTs had high quality of evidence, which ensured the reliability of the meta-analysis results. CONCLUSIONS Awake prone positioning is safe and feasible in non-intubated patients with AHRF caused by COVID-19, and can significantly reduce the intubation rate. More studies are needed to explore standardized implementation strategies for the awake prone positioning. TRIAL REGISTRATION CRD42023394113.
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Affiliation(s)
- Wen Cao
- Department of Critical Medicine, the Second Hospital of Lanzhou University, Lanzhou, 730030, China.
| | - Nannan He
- Department of Critical Medicine, the Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Yannian Luo
- Department of Critical Medicine, the Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Zhiming Zhang
- Department of Oncology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 730030, China.
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Tamlyn AL, Tjilos M, Bosch NA, Barnett KG, Perkins RB, Walkey A, Assoumou SA, Linas BP, Drainoni M. At the intersection of trust and mistrust: A qualitative analysis of motivators and barriers to research participation at a safety-net hospital. Health Expect 2023; 26:1118-1126. [PMID: 36896842 PMCID: PMC10154811 DOI: 10.1111/hex.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION The underrepresentation of Black, Indigenous, and People of Color (BIPOC) individuals in healthcare research limits generalizability and contributes to healthcare inequities. Existing barriers and attitudes toward research participation must be addressed to increase the representation of safety net and other underserved populations. METHODS We conducted semi-structured qualitative interviews with patients at an urban safety net hospital, focusing on facilitators, barriers, motivators, and preferences for research participation. We conducted direct content analysis guided by an implementation framework and used rapid analysis methods to generate final themes. RESULTS We completed 38 interviews and identified six major themes related to preferences for engagement in research participation: (1) wide variation in research recruitment preferences; (2) logistical complexity negatively impacts willingness to participate; (3) risk contributes to hesitation toward research participation; (4) personal/community benefit, interest in study topic, and compensation serve as motivators for research participation; (5) continued participation despite reported shortcomings of informed consent process; and (6) mistrust could be overcome by relationship or credibility of information sources. CONCLUSION Despite barriers to participation in research studies among safety-net populations, there are also facilitators that can be implemented to increase knowledge and comprehension, ease of participation, and willingness to join research studies. Study teams should vary recruitment and participation methods to ensure equal access to research opportunities. PATIENT/PUBLIC CONTRIBUTION Our analysis methods and study progress were presented to individuals within the Boston Medical Center healthcare system. Through this process community engagement specialists, clinical experts, research directors, and others with significant experience working with safety-net populations supported data interpretation and provided recommendations for action following the dissemination of data.
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Affiliation(s)
| | - Maria Tjilos
- Boston Medical Center, Section of Infectious DiseaseBostonMAUSA
| | - Nicholas A. Bosch
- Boston Medical Center, The Pulmonary Center, Department of MedicineBostonMAUSA
- Boston University Chobanian & Avedisian School of Medicine, Section of Pulmonary, Allergy, Sleep, & Critical Care, Department of MedicineBostonMAUSA
| | - Katherine Gergen Barnett
- Boston Medical Center, Department of Family MedicineBostonMAUSA
- Boston University Chobanian & Avedisian School of Medicine, Department of Family MedicineBostonMAUSA
- Harvard Center for Primary Care, Center for Primary CareBostonMAUSA
- Aspen Health InnovationWashingtonDCUSA
| | - Rebecca B. Perkins
- Boston Medical Center, Department of Obstetrics and GynecologyBostonMAUSA
- Boston University Chobanian & Avedisian School of Medicine, Department of Obstetrics and GynecologyBostonMAUSA
| | - Allan Walkey
- Boston Medical Center, The Pulmonary Center, Department of MedicineBostonMAUSA
- Boston University Chobanian & Avedisian School of Medicine, Section of Pulmonary, Allergy, Sleep, & Critical Care, Department of MedicineBostonMAUSA
- Boston University School of Public Health, Department of Health Law Policy & ManagementBostonMAUSA
| | - Sabrina A. Assoumou
- Boston Medical Center, Section of Infectious DiseaseBostonMAUSA
- Boston University Chobanian & Avedisian School of Medicine, Section of Infectious Disease Department of MedicineBostonMAUSA
| | - Benjamin P. Linas
- Boston Medical Center, Section of Infectious DiseaseBostonMAUSA
- Boston University Chobanian & Avedisian School of Medicine, Section of Infectious Disease Department of MedicineBostonMAUSA
- Boston University School of Public Health, Department of EpidemiologyBostonMAUSA
| | - Mari‐Lynn Drainoni
- Boston University School of Public Health, Department of Health Law Policy & ManagementBostonMAUSA
- Boston University Chobanian & Avedisian School of Medicine, Section of Infectious Disease Department of MedicineBostonMAUSA
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Qin S, Chang W, Peng F, Hu Z, Yang Y. Awake prone position in COVID-19-related acute respiratory failure: a meta-analysis of randomized controlled trials. BMC Pulm Med 2023; 23:145. [PMID: 37101160 PMCID: PMC10131466 DOI: 10.1186/s12890-023-02442-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND We aimed to investigate the effects of awake prone positioning (APP) in nonintubated adult patients with acute hypoxemic respiratory failure due to COVID-19. METHODS The PubMed, Embase, Web of Science and Cochrane Central Register databases were searched up to June 1, 2022. All randomized trials investigating the effects of APP were included in the present meta-analysis. The primary outcome was intubation rate, and the secondary outcomes included the length of intensive care unit (ICU) stay, hospital stay, and mortality. Prescribed subgroup analysis was also conducted. RESULTS A total of 10 randomized trials enrolling 2324 patients were ultimately included in the present study. The results indicated that APP was associated with a significant reduction in the intubation rate (OR 0.77, 95% CI 0.63 to 0.93, P = 0.007). However, no differences could be observed in the length of ICU stay or hospitalization or mortality. Subgroup analysis suggested that patients in the ICU settings (OR 0.74, 95% CI 0.60 to 0.91, P = 0.004), patients whose median APP time was more than 4 h (OR 0.77, 95% CI 0.63 to 0.93, P = 0.008), and patients with an average baseline SpO2 to FiO2 ratio less than 200 (OR 0.75, 95% CI 0.61 to 0.92) were more likely to benefit from APP, indicated a significantly reduced intubation rate. CONCLUSION Based on the current evidence, nonintubated adult patients with hypoxemic respiratory failure due to COVID-19 infection who underwent APP were shown to have a significantly reduced intubation rate. However, no differences in ICU or hospital length of stay or mortality could be observed between APP and usual care. REGISTRATION NUMBER CRD42022337846.
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Affiliation(s)
- Sun Qin
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Wei Chang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Fei Peng
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Zihan Hu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China.
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11
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Rampon GL, Simpson SQ, Agrawal R. Prone Positioning for Acute Hypoxemic Respiratory Failure and ARDS: A Review. Chest 2023; 163:332-340. [PMID: 36162482 DOI: 10.1016/j.chest.2022.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 01/14/2023] Open
Abstract
Prone positioning is an immediately accessible, readily implementable intervention that was proposed initially as a method for improvement in gas exchange > 50 years ago. Initially implemented clinically as an empiric therapy for refractory hypoxemia, multiple clinical trials were performed on the use of prone positioning in various respiratory conditions, cumulating in the landmark Proning Severe ARDS Patients trial, which demonstrated mortality benefit in patients with severe ARDS. After this trial and the corresponding meta-analysis, expert consensus and societal guidelines recommended the use of prone positioning for the management of severe ARDS. The ongoing COVID-19 pandemic has brought prone positioning to the forefront of medicine, including widespread implementation of prone positioning in awake, spontaneously breathing, nonintubated patients with acute hypoxemic respiratory failure. Multiple clinical trials now have been performed to investigate the safety and effectiveness of prone positioning in these patients and have enhanced our understanding of the effects of the prone position in respiratory failure. In this review, we discuss the physiologic features, clinical outcome data, practical considerations, and lingering questions of prone positioning.
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Affiliation(s)
- Garrett L Rampon
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Steven Q Simpson
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS.
| | - Ritwick Agrawal
- Pulmonary Critical Care and Sleep Medicine Section, Medical Care Line, Michael E. DeBakey Veteran Affairs Medical Center, Houston, TX; Pulmonary Critical Care and Sleep Medicine Section, Department of Medicine, Baylor College of Medicine, Houston, TX
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12
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Cheema HA, Siddiqui A, Ochani S, Adnan A, Sukaina M, Haider R, Shahid A, Rehman MEU, Awan RU, Singh H, Duric N, Fazzini B, Torres A, Szakmany T. Awake Prone Positioning for Non-Intubated COVID-19 Patients with Acute Respiratory Failure: A Meta-Analysis of Randomised Controlled Trials. J Clin Med 2023; 12:926. [PMID: 36769574 PMCID: PMC9917863 DOI: 10.3390/jcm12030926] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/24/2022] [Accepted: 01/22/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Awake prone positioning (APP) has been widely applied in non-intubated patients with COVID-19-related acute hypoxemic respiratory failure. However, the results from randomised controlled trials (RCTs) are inconsistent. We performed a meta-analysis to assess the efficacy and safety of APP and to identify the subpopulations that may benefit the most from it. METHODS We searched five electronic databases from inception to August 2022 (PROSPERO registration: CRD42022342426). We included only RCTs comparing APP with supine positioning or standard of care with no prone positioning. Our primary outcomes were the risk of intubation and all-cause mortality. Secondary outcomes included the need for escalating respiratory support, length of ICU and hospital stay, ventilation-free days, and adverse events. RESULTS We included 11 RCTs and showed that APP reduced the risk of requiring intubation in the overall population (RR 0.84, 95% CI: 0.74-0.95; moderate certainty). Following the subgroup analyses, a greater benefit was observed in two patient cohorts: those receiving a higher level of respiratory support (compared with those receiving conventional oxygen therapy) and those in intensive care unit (ICU) settings (compared to patients in non-ICU settings). APP did not decrease the risk of mortality (RR 0.93, 95% CI: 0.77-1.11; moderate certainty) and did not increase the risk of adverse events. CONCLUSIONS In patients with COVID-19-related acute hypoxemic respiratory failure, APP likely reduced the risk of requiring intubation, but failed to demonstrate a reduction in overall mortality risk. The benefits of APP are most noticeable in those requiring a higher level of respiratory support in an ICU environment.
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Affiliation(s)
- Huzaifa Ahmad Cheema
- Intensive Care Unit, Department of Chest Medicine, King Edward Medical University, Lahore 54000, Pakistan
| | - Amna Siddiqui
- Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan
| | - Sidhant Ochani
- Department of Medicine, Khairpur Medical College, Khairpur 66020, Pakistan
| | - Alishba Adnan
- Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan
| | - Mahnoor Sukaina
- Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan
| | - Ramsha Haider
- Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan
| | - Abia Shahid
- Intensive Care Unit, Department of Chest Medicine, King Edward Medical University, Lahore 54000, Pakistan
| | | | - Rehmat Ullah Awan
- Department of Medicine, Ochsner Rush Medical Center, Meridian, MS 39301, USA
| | - Harpreet Singh
- Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Natalie Duric
- Critical Care Directorate, The Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran NP44 2XJ, UK
| | - Brigitta Fazzini
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Antoni Torres
- Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, 08036 Barcelona, Spain
- CibeRes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 06/06/0028), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 28029 Barcelona, Spain
- School of Medicine, University of Barcelona, 08036 Barcelona, Spain
| | - Tamas Szakmany
- Critical Care Directorate, The Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran NP44 2XJ, UK
- Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff CF14 4XN, UK
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13
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Peng Q, Yang S, Zhang Y, Zhao W, Hu M, Meng B, Ni H, Min L, Yu J, Wang Y, Zhang L. Effects of awake prone position vs. usual care on acute hypoxemic respiratory failure in patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne) 2023; 10:1120837. [PMID: 37081841 PMCID: PMC10111056 DOI: 10.3389/fmed.2023.1120837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/06/2023] [Indexed: 04/22/2023] Open
Abstract
Background Previous studies have shown that an awake prone position may be beneficial for the treatment of acute respiratory distress syndrome (ARDS) or acute hypoxic respiratory failure (AHRF) in patients with COVID-19, but the results are not consistent, especially in terms of oxygenation outcomes and intubation rate. This systematic review and meta-analysis assessed the effects of the awake prone position on AHRF in patients with COVID-19 with all randomized controlled trials (RCTs). Methods An extensive search of online databases, including MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials from 1 December 2019 to 30 October 2022, with no language restrictions was performed. This systematic review and meta-analysis are based on the PRISMA statement. We only included RCTs and used the Cochrane risk assessment tool for quality assessment. Results Fourteen RCTs fulfilled the selection criteria, and 3,290 patients were included. A meta-analysis found that patients in the awake prone position group had more significant improvement in the SpO2/FiO2 ratio [mean difference (MD): 29.76; 95% confidence interval (CI): 1.39-48.13; P = 0.001] compared with the usual care. The prone position also reduced the need for intubation [odd ratio (OR): 0.72; 95% CI: 0.61 to 0.84; P < 0.0001; I 2 = 0%]. There was no significant difference in mortality, hospital length of stay, incidence of intensive care unit (ICU) admission, and adverse events between the two groups. Conclusion The awake prone position was a promising intervention method, which is beneficial to improve the oxygenation of patients with ARDS or AHRF caused by COVID-19 and reduce the need for intubation. However, the awake prone position showed no obvious advantage in mortality, hospital length of stay, incidence of ICU admission, and adverse events. Systematic review registration International Prospective Register of Systematic Reviews (PROSPERO), identifier: CRD42022367885.
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Affiliation(s)
- Qing Peng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Sheng Yang
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Yu Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Wenjie Zhao
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Man Hu
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Bo Meng
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Huanhuan Ni
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Lingfeng Min
- Department of Respiratory, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jiangquan Yu
- Department of Critical Care Medicine, Clinical Medical College of Yangzhou University, Yangzhou, China
- *Correspondence: Jiangquan Yu
| | - Yongxiang Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
- Yongxiang Wang
| | - Liang Zhang
- Department of Orthopedics, Regenerative Medicine Engineering Technology Research Center of Yangzhou, Yangzhou, China
- Liang Zhang
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Affiliation(s)
- Amol A Verma
- Department of Medicine and Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Fahad Razak
- Department of Medicine and Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Laveena Munshi
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Michael Fralick
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
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15
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Weatherald J, Parhar KKS, Al Duhailib Z, Chu DK, Granholm A, Solverson K, Lewis K, Møller MH, Alshahrani M, Belley-Cote E, Loroff N, Qian ET, Gatto CL, Rice TW, Niven D, Stelfox HT, Fiest K, Cook D, Arabi YM, Alhazzani W. Efficacy of awake prone positioning in patients with covid-19 related hypoxemic respiratory failure: systematic review and meta-analysis of randomized trials. BMJ 2022; 379:e071966. [PMID: 36740866 PMCID: PMC9727649 DOI: 10.1136/bmj-2022-071966] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of awake prone positioning versus usual care in non-intubated adults with hypoxemic respiratory failure due to covid-19. DESIGN Systematic review with frequentist and bayesian meta-analyses. STUDY ELIGIBILITY Randomized trials comparing awake prone positioning versus usual care in adults with covid-19 related hypoxemic respiratory failure. Information sources were Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to 4 March 2022. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed risk of bias. Random effects meta-analyses were performed for the primary and secondary outcomes. Bayesian meta-analyses were performed for endotracheal intubation and mortality outcomes. GRADE certainty of evidence was assessed for outcomes. MAIN OUTCOME MEASURES The primary outcome was endotracheal intubation. Secondary outcomes were mortality, ventilator-free days, intensive care unit (ICU) and hospital length of stay, escalation of oxygen modality, change in oxygenation and respiratory rate, and adverse events. RESULTS 17 trials (2931 patients) met the eligibility criteria. 12 trials were at low risk of bias, three had some concerns, and two were at high risk. Awake prone positioning reduced the risk of endotracheal intubation compared with usual care (crude average 24.2% v 29.8%, relative risk 0.83, 95% confidence interval 0.73 to 0.94; high certainty). This translates to 55 fewer intubations per 1000 patients (95% confidence interval 87 to 19 fewer intubations). Awake prone positioning did not significantly affect secondary outcomes, including mortality (15.6% v 17.2%, relative risk 0.90, 0.76 to 1.07; high certainty), ventilator-free days (mean difference 0.97 days, 95% confidence interval -0.5 to 3.4; low certainty), ICU length of stay (-2.1 days, -4.5 to 0.4; low certainty), hospital length of stay (-0.09 days, -0.69 to 0.51; moderate certainty), and escalation of oxygen modality (21.4% v 23.0%, relative risk 1.04, 0.74 to 1.44; low certainty). Adverse events related to awake prone positioning were uncommon. Bayesian meta-analysis showed a high probability of benefit with awake prone positioning for endotracheal intubation (non-informative prior, mean relative risk 0.83, 95% credible interval 0.70 to 0.97; posterior probability for relative risk <0.95=96%) but lower probability for mortality (0.90, 0.73 to 1.13; <0.95=68%). CONCLUSIONS Awake prone positioning compared with usual care reduces the risk of endotracheal intubation in adults with hypoxemic respiratory failure due to covid-19 but probably has little to no effect on mortality or other outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022314856.
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Affiliation(s)
- Jason Weatherald
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
- Contributed equally
| | - Ken Kuljit S Parhar
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada
- O'Brien Institute for Public Health, Calgary, AB, Canada
- Contributed equally
| | - Zainab Al Duhailib
- Critical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Derek K Chu
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Anders Granholm
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Kevin Solverson
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada
| | - Kimberley Lewis
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Mohammed Alshahrani
- Department of Emergency and Critical Care, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Emilie Belley-Cote
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Nicole Loroff
- Knowledge Resource Service, Alberta Health Services, Edmonton, AB, Canada
| | - Edward T Qian
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cheryl L Gatto
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd W Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dan Niven
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada
- O'Brien Institute for Public Health, Calgary, AB, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada
- O'Brien Institute for Public Health, Calgary, AB, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada
- O'Brien Institute for Public Health, Calgary, AB, Canada
| | - Deborah Cook
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Yaseen M Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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16
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Protti A, Lanza E. Should We Encourage Prone Positioning in Patients With Non-Severe COVID-19? Chest 2022; 162:731-733. [PMID: 36210097 PMCID: PMC9535239 DOI: 10.1016/j.chest.2022.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Alessandro Protti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,CORRESPONDENCE TO: Alessandro Protti, MD
| | - Ezio Lanza
- Department of Anesthesia and Intensive Care Units and Radiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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