Prolonged vs shorter awake prone positioning for COVID-19 patients with acute respiratory failure: a multicenter, randomised controlled trial

作者：Ling Liu, Qin Sun, Hongsheng Zhao, Weili Liu, Xuehua Pu, Jibin Han, Jiangquan Yu, Jun Jin, Yali Chao, Sicong Wang, Yu Liu, Bin Wu, Ying Zhu, Yang Li, Wei Chang, Tao Chen, Jianfeng Xie, Yi Yang, Haibo Qiu, Arthur S. Slutsky, Ling Liu, Haibo Qiu, Hongsheng Zhao, Shu Lu, Chenliang Sun, Weili Liu, Yali Chao, Ying Zhu, Ruiqiang Zheng, Jiangquan Yu, Jun Wang, Jun Jin, Xuehua Pu, Yu Liu, Qindong Shi, Hongliang Wang, Sicong Wang, Bin Wu, Huaguang Ye, Jibin Han, Tao Chen, Qin Sun, Wei Chang, Bingwei Chen, Tao Chen · 发表于：Intensive Care Medicine · 年份：2024 · DOI：10.1007/s00134-024-07545-x · 被引用次数：29 · 研究领域：Respiratory Support and Mechanisms、Airway Management and Intubation Techniques、Pneumothorax, Barotrauma, Emphysema

PURPOSE: Awake prone positioning has been reported to reduce endotracheal intubation in patients with coronavirus disease 2019 (COVID-19)-related acute hypoxemic respiratory failure (AHRF). However, it is still unclear whether using the awake prone positioning for longer periods can further improve outcomes. METHODS: In this randomized, open-label clinical trial conducted at 12 hospitals in China, non-intubated patients with COVID-19-related AHRF were randomly assigned to prolonged awake prone positioning (target > 12 h daily for 7 days) or standard care with a shorter period of awake prone positioning. The primary outcome was endotracheal intubation within 28 days after randomization. The key secondary outcomes included mortality and adverse events. RESULTS: In total, 409 patients were enrolled and randomly assigned to prolonged awake prone positioning (n = 205) or standard care (n = 204). In the first 7 days after randomization, the median duration of prone positioning was 12 h/d (interquartile range [IQR] 12-14 h/d) in the prolonged awake prone positioning group vs. 5 h/d (IQR 2-8 h/d) in the standard care group. In the intention-to-treat analysis, intubation occurred in 35 (17%) patients assigned to prolonged awake prone positioning and in 56 (27%) patients assigned to standard care (relative risk 0.62 [95% confidence interval (CI) 0.42-0.9]). The hazard ratio (HR) for intubation was 0.56 (0.37-0.86), and for mortality was 0.63 (0.42-0.96) for prolonged awake prone positi...