Association of awake prone positioning with clinical outcomes in severe immune checkpoint inhibitor-associated pneumonitis with acute hypoxemic respiratory failure: a propensity-matched retrospective cohort study

作者：Changhao Yin, Yan Qiang, Zhen Mei, Changzhen Qi, Qian Chen, Jisheng Zhou, Xiaoyan Fan · 发表于：Frontiers in Medicine · 年份：2026 · DOI：10.3389/fmed.2026.1880206 · 研究领域：Respiratory Support and Mechanisms、Cancer Immunotherapy and Biomarkers、Pneumothorax, Barotrauma, Emphysema

Objective Severe immune checkpoint inhibitor (ICI)-associated pneumonitis can lead to acute hypoxemic respiratory failure and substantial mortality. This study evaluated the association between awake prone positioning (APP) and clinical outcomes in patients with clinically diagnosed severe ICI-associated pneumonitis. Methods In this single-center retrospective cohort study, 120 propensity-matched patients with clinically diagnosed severe ICI-associated pneumonitis and acute hypoxemic respiratory failure between January 2019 and September 2024 were analyzed. Infectious pneumonia, COVID-19 pneumonia, opportunistic infection, tumor progression, radiation pneumonitis, cardiogenic pulmonary edema, pulmonary embolism, diffuse alveolar hemorrhage, and other dominant alternative causes of respiratory failure were excluded through structured diagnostic adjudication. Patients were classified into the APP group ( n = 60, cumulative APP duration ≥10 h during the first ICU week) or control group ( n = 60) according to documented positioning exposure. Primary outcomes were dynamic PaO₂/FiO₂ ratio trajectories and endotracheal intubation rates; secondary outcomes included ICU length of stay and 28-day all-cause mortality. Sensitivity analyses addressed pandemic period, APP exposure timing, FiO₂ documentation, and competing risk for ICU discharge. Results APP was associated with a higher PaO₂/FiO₂ ratio at 168 h (268 ± 52 vs. 201 ± 49 mmHg, p < 0.001) and a lower intubation rate [11/6...