Response to lying awake in non-intubated people with COVID-19

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Respiratory care. November 23, 2021: respcare.08982. doi: 10.4187 / respcare.08982. Online ahead of print.


BACKGROUND: The prone position is used for patients with ARDS undergoing invasive mechanical ventilation; its effectiveness in awake unventilated patients is unclear. Our objective was to assess the effectiveness of the prone maneuver in reducing the risk of intubation and increasing the chances of favorable events.

METHODS: We prospectively evaluated 66 subjects with moderate COVID-19-related ARDS who were admitted to the ICU; treated with a high-flow nasal cannula, non-invasive ventilation, reservoir mask or nasal cannula; and subjected to arousal maneuvers from March 1, 2020 to August 30, 2020. The following factors were recorded on admission to intensive care: age, sex, previous illness, simplified acute physiology score 3, body mass index and changes in gas exchange after and before lying down. Subjects were divided into a responder and non-responder group based on a 20% increase in PaO2 / FOI2 report before and after the maneuver. The need for intubation within 48 hours of the start of the maneuver was also assessed. We also analyzed the differences in mortality, length of ICU stay, length of hospital stay, and duration of mechanical ventilation. A generalized estimating equation model was applied to the pre- and post-problem means. To control for confounding factors, a multivariate Poisson regression was applied.

RESULTS: Forty-one subjects aged 54.1 ± 12.9 years were recruited. Responders showed an increase in SpO2 (P <.001 p>aO2 (P <.001 and p>aO2 / FOI2 reports (P <.001 with the maneuver and a reduced respiratory rate. interveners had shorter lengths of stay in icu>P <.001 and hospital>P P <.012 fewer ventilation days>P <.02 and lower mortality>P <.001 subjects who responded to the maneuver had a reduction in risk of ventilation and extended stay intensive care.>

CONCLUSIONS: Among the responders to the supine position, there were fewer deaths, shorter duration of mechanical ventilation, shorter length of stay in intensive care, and shorter length of stay in hospital.

PMID: 34815324 | DOI: 10.4187 / respcare.08982

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