Early awake proning in critical and severe COVID-19 patients undergoing noninvasive respiratory support: A retrospective multicenter cohort study

• DOI: 10.1016/j.pulmoe.2021.03.002
• Publication Date: 2021-03-23T09:58:38Z
• Authors: Roberto Tonelli; Lara Pisani; Luca Tabbì; Vittoria Comellini; Irene Prediletto; Riccardo Fantini; Alessandro Marchioni; Dario Andrisani; Filippo Gozzi; Giulia Bruzzi; Linda Manicardi; Stefano Busani; Cristina Mussini; Ivana Castaniere; Ilaria Bassi; Marco Carpano; Federico Tagariello; Gabriele Corsi; Roberto d’Amico; Massimo Girardis; Stefano Nava; Enrico Clini
• Keywords: Clinical endpoint; Respiratory Rate; Spontaneous breathing trial

This retrospective cohort study was conducted in two teaching hospitals over a 3-month period (March 2010-June 2020) comparing severe and critical COVID-19 patients admitted to Respiratory Intensive Care Unit for non-invasive respiratory support (NRS) subjected awake prone position (PP) with those receiving standard care (SC). Primary outcome endotracheal intubation (ETI) rate. In-hospital mortality, time ETI, tracheostomy, length of RICU hospital stay served as secondary outcomes. Risk factors associated ETI among PP were also investigated.A total 114 included, 76 the SC 38 group. Unadjusted Kaplan-Meier estimates showed greater effect compared on rate (HR = 0.45 95% CI [0.2-0.9], p 0.02) even after adjustment baseline confounders 0.59 [0.3-0.94], 0.03). After stratification according support, significant benefit High Flow Nasal Cannulae 0.34 [0.12-0.84], 0.04). Compared SC, favorable difference terms days free from while mortality tracheostomy not significantly different.Prone positioning spontaneously breathing Covid-19 is feasible reduction rate, especially undergoing HFNC. Although our results are intriguing, further randomized controlled trials needed answer all open questions remaining pending about real efficacy this setting.