Early physiologic changes after awake prone positioning predict clinical outcomes in patients with acute hypoxemic respiratory failure

• Published in: Intensive care medicine 2024-12, Vol.50 (12), p.2105-2113
• Main Authors: Olmos, Matias, Esperatti, Mariano, Fuentes, Nora, Miranda Tirado, Anabel, Gonzalez, María Eugenia, Kakisu, Hiromi, Suarez, Juan, Tisminetzky, Manuel, Barbaresi, Veronica, Santomil, Ignacio, Bruhn Cruz, Alejandro, Grieco, Domenico Luca, Ferreyro, Bruno L.
• Format: Article
• Language: English
• Subjects: Aged; Anesthesiology; Confidence intervals; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - physiopathology; COVID-19 - therapy; Critical Care Medicine; Death; Emergency Medicine; Failure; Female; Health services; Humans; Hypoxia - physiopathology; Hypoxia - therapy; Intensive; Intensive care; Intubation; Intubation, Intratracheal - methods; Intubation, Intratracheal - statistics & numerical data; Male; Mechanical ventilation; Medicine; Medicine & Public Health; Middle Aged; Original; Oxygenation; Pain Medicine; Parameter identification; Patient positioning; Patient Positioning - methods; Patients; Pediatrics; Pneumology/Respiratory System; Prone Position - physiology; Prospective Studies; Respiration; Respiration, Artificial - methods; Respiratory Distress Syndrome - mortality; Respiratory Distress Syndrome - physiopathology; Respiratory Distress Syndrome - therapy; Respiratory failure; Respiratory Insufficiency - etiology; Respiratory Insufficiency - physiopathology; Respiratory Insufficiency - therapy; Respiratory Rate; SARS-CoV-2; Wakefulness - physiology
• ISSN: 0342-4642; 1432-1238; 1432-1238
• DOI: 10.1007/s00134-024-07690-3

Purpose The optimal physiologic parameters to monitor after a session of awake prone positioning in patients with acute respiratory failure are not well understood. This study aimed to identify which early physiologic changes after the first session of awake prone positioning are linked to the need for invasive mechanical ventilation or death in patients with acute respiratory failure. Methods We performed a secondary analysis of a prospective cohort study of adult patients with acute respiratory failure related to coronavirus disease 2019 (COVID-19) treated with awake prone positioning. We assessed the association between relative changes in physiological variables (oxygenation, respiratory rate, pCO 2 and respiratory rate-oxygenation [ROX] index) within the first 6 h of the first awake prone positioning session with treatment failure, defined as endotracheal intubation and/or death within 7 days. Results 244 patients [70 female (29%), mean age 60 (standard deviation [SD] 13) years] were included. Seventy-one (29%) patients experienced awake prone positioning failure. ROX index was the main physiologic predictor. Patients with treatment failure had lower mean [SD] ROX index at baseline [5 (1.4) versus 6.6 (2.2), p