Changes in oxygenation and clinical outcomes with awake prone positioning in patients with suspected COVID-19 In Low-Resource settings: A retrospective cohort study

Introduction: This study aimed to describe the use of awake prone positioning (APP) and conventional oxygen therapy (COT) in patients with suspected coronavirus disease (COVID-19) and respiratory failure in a limited-resource setting. Methods: This was a retrospective cohort study of hospitalized pa...

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Autores:: Dueñas-Castell, Carmelo
Borre-Naranjo, Diana
Rodelo, Dairo
Lora, Leydis
Almanza, Amilkar
Coronell, Wilfrido
Rojas-Suarez, José

Tipo de recurso:

Fecha de publicación:: 2023

Institución:: Universidad Simón Bolívar

Repositorio:: Repositorio Digital USB

Idioma:: eng

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dc.title.eng.fl_str_mv	Changes in oxygenation and clinical outcomes with awake prone positioning in patients with suspected COVID-19 In Low-Resource settings: A retrospective cohort study
title	Changes in oxygenation and clinical outcomes with awake prone positioning in patients with suspected COVID-19 In Low-Resource settings: A retrospective cohort study
spellingShingle	Changes in oxygenation and clinical outcomes with awake prone positioning in patients with suspected COVID-19 In Low-Resource settings: A retrospective cohort study Awake prone position Oxygenation Respiratory failure COVID-19 Mortality Resources
title_short	Changes in oxygenation and clinical outcomes with awake prone positioning in patients with suspected COVID-19 In Low-Resource settings: A retrospective cohort study
title_full	Changes in oxygenation and clinical outcomes with awake prone positioning in patients with suspected COVID-19 In Low-Resource settings: A retrospective cohort study
title_fullStr	Changes in oxygenation and clinical outcomes with awake prone positioning in patients with suspected COVID-19 In Low-Resource settings: A retrospective cohort study
title_full_unstemmed	Changes in oxygenation and clinical outcomes with awake prone positioning in patients with suspected COVID-19 In Low-Resource settings: A retrospective cohort study
title_sort	Changes in oxygenation and clinical outcomes with awake prone positioning in patients with suspected COVID-19 In Low-Resource settings: A retrospective cohort study
dc.creator.fl_str_mv	Dueñas-Castell, Carmelo Borre-Naranjo, Diana Rodelo, Dairo Lora, Leydis Almanza, Amilkar Coronell, Wilfrido Rojas-Suarez, José
dc.contributor.author.none.fl_str_mv	Dueñas-Castell, Carmelo Borre-Naranjo, Diana Rodelo, Dairo Lora, Leydis Almanza, Amilkar Coronell, Wilfrido Rojas-Suarez, José
dc.subject.eng.fl_str_mv	Awake prone position Oxygenation Respiratory failure COVID-19 Mortality Resources
topic	Awake prone position Oxygenation Respiratory failure COVID-19 Mortality Resources
description	Introduction: This study aimed to describe the use of awake prone positioning (APP) and conventional oxygen therapy (COT) in patients with suspected coronavirus disease (COVID-19) and respiratory failure in a limited-resource setting. Methods: This was a retrospective cohort study of hospitalized patients aged ≥18 years old who were placed in an awake prone position due to hypoxemic respiratory failure and suspected COVID-19. The patients were selected from a tertiary center in Cartagena, Colombia, between March 1, 2020, and August 31, 2020. Demographic, clinical, and laboratory variables were collated, and all the variables were compared between the groups. Results: The median age of the participants was 63 (IQR, 48.8-73) years (survivors: 59 [IQR, 43.568] years vs. non-survivors: 70 [IQR, 63-78] years, P ≤.001). Of the 1470 patients admitted for respiratory symptoms, 732 (49.8%) were hospitalized for more than 24 h, and 212 patients developed respiratory failure and required COT and APP (overall hospital mortality, 34% [73/212]). The mean rank difference in PaO2/FiO2 before and after APP was higher in the survivors than in the non-survivors (201.1-252.6, mean rank difference =51.5, P=.001 vs. 134.1-172.4, mean rank difference=38.28, P=.24, respectively). Conclusion: While using COT in conjunction with APP can improve respiratory failure in patients with suspected COVID-19 in low-resource settings, persistent hypoxemia after APP can identify patients with higher mortality risk. More evidence is needed to establish the role of this strategy.
publishDate	2023
dc.date.accessioned.none.fl_str_mv	2023-05-16T21:39:22Z
dc.date.available.none.fl_str_mv	2023-05-16T21:39:22Z
dc.date.issued.none.fl_str_mv	2023
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dc.type.spa.spa.fl_str_mv	Artículo científico
dc.identifier.issn.none.fl_str_mv	15251489 08850666
dc.identifier.uri.none.fl_str_mv	https://hdl.handle.net/20.500.12442/12403
dc.identifier.doi.none.fl_str_mv	https://doi.org/10.1177/08850666211049333
dc.identifier.url.none.fl_str_mv	https://journals.sagepub.com/doi/full/10.1177/08850666211049333
identifier_str_mv	15251489 08850666
url	https://hdl.handle.net/20.500.12442/12403 https://doi.org/10.1177/08850666211049333 https://journals.sagepub.com/doi/full/10.1177/08850666211049333
dc.language.iso.eng.fl_str_mv	eng
language	eng
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dc.format.mimetype.spa.fl_str_mv	pdf
dc.publisher.spa.fl_str_mv	SAGE Publications Facultad de Ciencias de la Salud
dc.source.eng.fl_str_mv	Journal of Intensive Care Medicine
dc.source.none.fl_str_mv	Vol 36 No. 11 (2023)
institution	Universidad Simón Bolívar
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spelling	Dueñas-Castell, Carmelo20e22541-3764-46e2-af10-3613ba9f7d6dBorre-Naranjo, Diana85200af3-e514-49e1-b1e5-d4e5a6b40902Rodelo, Dairo10e3f7f7-051b-48d7-b21c-08c006b70501Lora, Leydis7eabb960-1ea6-4d79-9b59-4bb982dfed7eAlmanza, Amilkar6a818a8e-a49d-4601-92ab-ada5ac135e02Coronell, Wilfridoa44f2d38-6e7e-4bbc-8b19-4bb12e2c4a6fRojas-Suarez, José69878f2a-bb4c-435c-a65d-0770de1641df2023-05-16T21:39:22Z2023-05-16T21:39:22Z20231525148908850666https://hdl.handle.net/20.500.12442/12403https://doi.org/10.1177/08850666211049333https://journals.sagepub.com/doi/full/10.1177/08850666211049333Introduction: This study aimed to describe the use of awake prone positioning (APP) and conventional oxygen therapy (COT) in patients with suspected coronavirus disease (COVID-19) and respiratory failure in a limited-resource setting. Methods: This was a retrospective cohort study of hospitalized patients aged ≥18 years old who were placed in an awake prone position due to hypoxemic respiratory failure and suspected COVID-19. The patients were selected from a tertiary center in Cartagena, Colombia, between March 1, 2020, and August 31, 2020. Demographic, clinical, and laboratory variables were collated, and all the variables were compared between the groups. Results: The median age of the participants was 63 (IQR, 48.8-73) years (survivors: 59 [IQR, 43.568] years vs. non-survivors: 70 [IQR, 63-78] years, P ≤.001). Of the 1470 patients admitted for respiratory symptoms, 732 (49.8%) were hospitalized for more than 24 h, and 212 patients developed respiratory failure and required COT and APP (overall hospital mortality, 34% [73/212]). The mean rank difference in PaO2/FiO2 before and after APP was higher in the survivors than in the non-survivors (201.1-252.6, mean rank difference =51.5, P=.001 vs. 134.1-172.4, mean rank difference=38.28, P=.24, respectively). Conclusion: While using COT in conjunction with APP can improve respiratory failure in patients with suspected COVID-19 in low-resource settings, persistent hypoxemia after APP can identify patients with higher mortality risk. More evidence is needed to establish the role of this strategy.pdfengSAGE PublicationsFacultad de Ciencias de la SaludAttribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Journal of Intensive Care MedicineVol 36 No. 11 (2023)Awake prone positionOxygenationRespiratory failureCOVID-19MortalityResourcesChanges in oxygenation and clinical outcomes with awake prone positioning in patients with suspected COVID-19 In Low-Resource settings: A retrospective cohort studyinfo:eu-repo/semantics/articleArtículo científicohttp://purl.org/coar/version/c_970fb48d4fbd8a85http://purl.org/coar/resource_type/c_2df8fbb1Chad T, Sampson C. Prone positioning in conscious patients on medical wards: a review of the evidence and its relevance to patients with COVID-19 infection. Clin Med. 2020 Jul 1 [cited 2021 Mar 10];20(4):e97–e103. Available from: https://www. rcpjournals.org/content/clinmedicine/20/4/e97, https://doi.org/10. 7861/clinmed.2020-0179Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in wuhan, China. Lancet. 2020 Feb;395(10223):497-506. https://doi.org/10.1016/S0140- 6736(20)30183-5Griffiths MJD, McAuley DF, Perkins GD, et al. Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respir Res. 2019;6(1):e000420. https://doi.org/10.1136/bmjresp- 2019-000420Tulleken JE, van der Werf TS, Ligtenberg JJ, Fijen JW, Zijlstra JG. Prone position in a spontaneously breathing near-drowning patient. Intensive Care Med. 1999;25:1469-1470. https://doi.org/ 10.1007/s001340051101Guérin C, Reignier J, Richard J-C, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013 Jun;368(23):2159-2168. https://doi.org/10.1056/NEJMoa1214103Scaravilli V, Grasselli G, Castagna L, et al. Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: a retrospective study. J Crit Care. 2015 Dec;30(6):1390-1394. https://doi.org/ 10.1016/j.jcrc.2015.07.008Pérez-Nieto OR, Guerrero-Gutiérrez MA, Deloya-Tomas E, Ñamendys-Silva SA. Prone positioning combined with high-flow nasal cannula in severe noninfectious ARDS. Crit Care. 2020;24(1):114. https://doi.org/10.1186/s13054-020-2821-yRaoof S, Nava S, Carpati C, Hill NS. High-Flow, noninvasive ventilation and awake (nonintubation) proning in patients With coronavirus disease 2019 With respiratory failure. Chest. 2020 Nov;158(5):1992-2002. https://doi.org/10.1016/j.chest. 2020.07.013Lee CC, Mankodi D, Shaharyar S, et al. High flow nasal cannula versus conventional oxygen therapy and non-invasive ventilation in adults with acute hypoxemic respiratory failure: a systematic review. Respir Med. 2016 Dec;121:100-108. https://doi.org/10. 1016/j.rmed.2016.11.004Schwabbauer N, Berg B, Blumenstock G, HaapM, Hetzel J, Riessen R. Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV). BMC Anesthesiol. 2014;14(66). https://doi.org/ 10.1186/1471-2253-14-66Weatherald J, Solverson K, Zuege DJ, Loroff N, Fiest KM, Parhar KKS. Awake prone positioning for COVID-19 hypoxemic respiratory failure: a rapid review. J Crit Care. 2021 Feb 1 [cited 2021 Mar 10];61:63-70. Available from: https://pubmed.ncbi.nlm. nih.gov/33096347, https://doi.org/10.1016/j.jcrc.2020.08.018Rosén J, von Oelreich E, Fors D, et al. Awake prone positioning in patients with hypoxemic respiratory failure due to COVID-19: the PROFLO multicenter randomized clinical trial. Crit Care. 2021 Jun;25(1):209. https://doi.org/10.1186/s13054-021-03602-9Bower G, He H. Protocol for awake prone positioning in COVID-19 patients: to do it earlier, easier, and longer. Crit Care. 2020; 24(1):371. https://doi.org/10.1186/s13054-020-03096-xElharrar X, Trigui Y, Dols A-M, et al. Use of prone positioning in nonintubated patients With COVID-19 and hypoxemic acute respiratory failure. JAMA. 2020 Jun;323(22):2336-2338. https://doi. org/10.1001/jama.2020.8255Caputo ND, Strayer RJ, Levitan R. Early self-proning in awake, Non-intubated patients in the emergency department: a single ED’s Experience during the COVID-19 pandemic. Acad Emerg Med. 2020 May;27(5):375-378. https://doi.org/10.1111/acem.13994Kangelaris KN, Ware LB, Wang CY, et al. Timing of intubation and clinical outcomes in adults With acute respiratory distress syndrome. Crit Care Med. 2016 Jan;44(1):120-129. https://doi.org/ 10.1097/CCM.0000000000001359Azoulay E, Fartoukh M, Darmon M, et al. Increased mortality in patients with severe SARS-CoV-2 infection admitted within seven days of disease onset. Intensive Care Med. 2020 Sep;46(9):1714-1722. https://doi.org/10.1007/s00134- 020-06202-3Hu Y, Sun J, Dai Z, et al. Prevalence and severity of corona virus disease 2019 (COVID-19): a systematic review and meta-analysis. J Clin Virol Off Publ Pan Am Soc Clin Virol. 2020 Jun; 127:104371. https://doi.org/10.1016/j.jcv.2020.104371Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020 May;109(5):531-538. https://doi.org/10.1007/ s00392-020-01626-9Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in wuhan, China: a retrospective cohort study. Lancet. 2020 Mar;395(10229):1054- 1062. https://doi.org/10.1016/S0140-6736(20)30566-3Izcovich A, Ragusa MA, Tortosa F, et al. Prognostic factors for severity and mortality in patients infected with COVID-19: a systematic review. PLoS One. 2020;15(11):e0241955. https://doi.org/ 10.1371/journal.pone.0241955Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2021 Jan;47(1):60-73. https://doi.org/10.1007/s00134-020- 06294-xLiu S, Yao N, Qiu Y, He C. Predictive performance of SOFA and qSOFA for in-hospital mortality in severe novel coronavirus disease. Am J Emerg Med. 2020 Oct;38(10):2074-2080. https:// doi.org/10.1016/j.ajem.2020.07.019Koeckerling D, Barker J, Mudalige NL, et al. Awake prone positioning in COVID-19. Thorax. 2020 Oct;75(10):833-834. https:// doi.org/10.1136/thoraxjnl-2020-215133Scholten EL, Beitler JR, Prisk GK, Malhotra A. Treatment of ARDS With prone positioning. Chest. 2017 Jan;151(1):215-224. https://doi.org/10.1016/j.chest.2016.06.032Xu Q, Wang T, Qin X, Jie Y, Zha L, Lu W. Early awake prone position combined with high-flow nasal oxygen therapy in severe COVID-19: a case series. Crit Care. 2020;24(1):250. https://doi.org/10.1186/s13054-020-02991-7Winearls S, Swingwood EL, Hardaker CL, et al. Early conscious prone positioning in patients with COVID-19 receiving continuous positive airway pressure: a retrospective analysis. BMJ Open Respir Res. 2020 Sep;7(1):e000711. https://doi.org/10. 1136/bmjresp-2020-000711Dikmen Y, Esquinas AM. Prone position in nonintubated hypoxemic respiratory failure. New tool to avoid endotracheal intubation? J Crit Care. Dec;2015;30(6):1415. https://doi.org/10.1016/ j.jcrc.2015.09.003Cardona S, Downing J, Alfalasi R, et al. Intubation rate of patients with hypoxia due to COVID-19 treated with awake proning: a meta-analysis. Am J Emerg Med. 2021 Jan;43:88-96. https://doi. org/10.1016/j.ajem.2021.01.058Sede BarranquillaEspecialización en Medicina Crítica y Cuidados IntensivosORIGINALPDF.pdfPDF.pdfapplication/pdf792564https://bonga.unisimon.edu.co/bitstreams/f52ece9a-31bf-464b-9a1e-db30cc0e448b/downloadb9ab5cd5f4019cee5185d87337548275MD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8805https://bonga.unisimon.edu.co/bitstreams/aef28c33-8c18-4554-9cac-59cfe7b7f384/download4460e5956bc1d1639be9ae6146a50347MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-8381https://bonga.unisimon.edu.co/bitstreams/81627b0f-28b5-41e5-b34c-1e91b334bdb6/download733bec43a0bf5ade4d97db708e29b185MD53TEXTChanges in Oxygenation and Clinical.pdf.txtChanges in Oxygenation and Clinical.pdf.txtExtracted texttext/plain30225https://bonga.unisimon.edu.co/bitstreams/e562b9fd-b2cb-46e6-ba2d-c610bbdead52/download81dd5783b27baad99682ff155555ddc7MD54PDF.txtPDF.txtExtracted texttext/plain30225https://bonga.unisimon.edu.co/bitstreams/5c00ee3d-2bba-4e69-af12-2ce8e5cae626/download81dd5783b27baad99682ff155555ddc7MD56PDF.pdf.txtPDF.pdf.txtExtracted texttext/plain30225https://bonga.unisimon.edu.co/bitstreams/adecaf78-645c-4296-a419-724b197704a6/download81dd5783b27baad99682ff155555ddc7MD58THUMBNAILChanges in Oxygenation and Clinical.pdf.jpgChanges in Oxygenation and Clinical.pdf.jpgGenerated Thumbnailimage/jpeg6753https://bonga.unisimon.edu.co/bitstreams/582e6baf-5c59-49c2-bacd-1407b4d63d4a/download4f6183720985c71a4ca6d252633df2baMD55PDF.jpgPDF.jpgGenerated Thumbnailimage/jpeg6753https://bonga.unisimon.edu.co/bitstreams/234c8903-a314-4961-b65a-3f9559ab6a97/download4f6183720985c71a4ca6d252633df2baMD57PDF.pdf.jpgPDF.pdf.jpgGenerated Thumbnailimage/jpeg6753https://bonga.unisimon.edu.co/bitstreams/b9d067ea-d6b7-412c-afb7-7a05dd5e5e95/download4f6183720985c71a4ca6d252633df2baMD5920.500.12442/12403oai:bonga.unisimon.edu.co:20.500.12442/124032024-08-14 21:54:09.591http://creativecommons.org/licenses/by-nc-nd/4.0/Attribution-NonCommercial-NoDerivatives 4.0 Internacionalrestrictedhttps://bonga.unisimon.edu.coRepositorio Digital Universidad Simón Bolívarrepositorio.digital@unisimon.edu.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

Changes in oxygenation and clinical outcomes with awake prone positioning in patients with suspected COVID-19 In Low-Resource settings: A retrospective cohort study

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