2026-04-13T02:42:12Zhttps://recercat.cat/oai/requestoai:recercat.cat:11351/80002025-10-24T10:33:32Zcom_2072_378070com_2072_378040col_2072_378092
RECERCAT
author
Ibarra-Estrada, Miguel
author
Li, Jie
author
Pavlov, Ivan
author
Perez, Yonatan
author
Roca Gas, Oriol
author
Tavernier, Elsa
2025-10-24T10:33:32Z
2025-10-24T10:33:32Z
2022-08-12T09:52:46Z2022-08-12T09:52:46Z2022-03-28
http://hdl.handle.net/11351/8000
Acute hypoxemic respiratory failure; COVID-19; IntubationInsuficiencia respiratoria hipoxémica aguda; COVID-19; IntubaciónInsuficiència respiratòria hipoxèmica aguda; COVID-19; IntubacióBackground
Awake prone positioning (APP) improves oxygenation in coronavirus disease (COVID-19) patients and, when successful, may decrease the risk of intubation. However, factors associated with APP success remain unknown. In this secondary analysis, we aimed to assess whether APP can reduce intubation rate in patients with COVID-19 and to focus on the factors associated with success.
Methods
In this multicenter randomized controlled trial, conducted in three high-acuity units, we randomly assigned patients with COVID-19-induced acute hypoxemic respiratory failure (AHRF) requiring high-flow nasal cannula (HFNC) oxygen to APP or standard care. Primary outcome was intubation rate at 28 days. Multivariate analyses were performed to identify the predictors associated to treatment success (survival without intubation).
Results
Among 430 patients randomized, 216 were assigned to APP and 214 to standard care. The APP group had a lower intubation rate (30% vs 43%, relative risk [RR] 0.70; CI95 0.54–0.90, P = 0.006) and shorter hospital length of stay (11 interquartile range [IQR, 9–14] vs 13 [IQR, 10–17] days, P = 0.001). A respiratory rate ≤ 25 bpm at enrollment, an increase in ROX index > 1.25 after first APP session, APP duration > 8 h/day, and a decrease in lung ultrasound score ≥ 2 within the first 3 days were significantly associated with treatment success for APP.
Conclusion
In patients with COVID-19-induced AHRF treated by HFNC, APP reduced intubation rate and improved treatment success. A longer APP duration is associated with APP success, while the increase in ROX index and decrease in lung ultrasound score after APP can also help identify patients most likely to benefit.
Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess
Insuficiència respiratòria - Tractament
COVID-19 (Malaltia) - Complicacions
DISEASES::Respiratory Tract Diseases::Respiration Disorders::Respiratory Insufficiency
Other subheadings::Other subheadings::/therapy
DISEASES::Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections
Other subheadings::Other subheadings::Other subheadings::/complications
ENFERMEDADES::enfermedades respiratorias::trastornos respiratorios::insuficiencia respiratoria
Otros calificadores::Otros calificadores::/terapia
ENFERMEDADES::virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus
Otros calificadores::Otros calificadores::Otros calificadores::/complicaciones
Factors for success of awake prone positioning in patients with COVID-19-induced acute hypoxemic respiratory failure: analysis of a randomized controlled trial
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion