Optimal timing for awake prone positioning in Covid-19 patients: Insights from an observational study from two centers

• Published in: International journal of nursing studies 2024-04, Vol.152, p.104707-104707, Article 104707
• Main Authors: Zhang, Weiqing, He, Yan, Gu, Qiuying, Zhang, Yin, Zha, Qinghua, Feng, Qing, Zhang, Shiyu, He, Yang, Kang, Lei, Xue, Min, Jing, Feng, Li, Jinling, Mao, Yanjun, Zhu, Weiyi
• Format: Article
• Language: English
• Subjects: Acute hypoxemic respiratory failure; Awake prone positioning; Coronavirus; COVID-19; Non-intubated
• ISSN: 0020-7489; 1873-491X
• DOI: 10.1016/j.ijnurstu.2024.104707

The widespread application and interest in awake prone positioning stems from its ease and availability and its ability to enhance patients' oxygenation. Nevertheless, due to the absence of consensus over the regimen of awake prone positioning, the efficacy of awake prone positioning remains uncertain. To explore the optimal regimen for awake prone positioning, including the timing of initiation, ideal daily duration, and strategies for improving patient comfort and encouraging adherence. Retrospective observational study. Two university-affiliated hospitals in Shanghai. Between December 2022 and February 2023, a total of 475 patients with COVID-19-related pneumonia who received awake prone positioning were observed. The data were collected from the hospital's electronic medical record system. The differentiation efficiency of peripheral blood oxygen saturation [SpO2]:fractional oxygen concentration in inspired air [FiO2] ratio at first awake prone positioning for different outcomes was tested by the area under the receiver operating characteristic curve. The Cox proportional hazard regression model was used to analyze the relationship between time to occurrence of 28-day outcomes and collected variables. Kaplan–Meier curves were plotted with the percentage of 28-day outcomes according to the SpO2:FiO2 ratio at first awake prone positioning after controlling covariates through Cox regression. The best efficiency in predicting patient outcomes was achieved when the cutoff SpO2:FiO2 ratio at first awake prone positioning was 200. Patients with a reduced SpO2:FiO2 ratio (≤200) experienced more adverse respiratory outcomes (RR = 5.42, 95%CI [3.35, 8.76], p