Efficacy of awake prone positioning for severe illness coronavirus disease 2019 patients: a propensity score‐adjusted cohort study

• Published in: Acute Medicine & Surgery Vol. 9; no. 1; pp. e734 - n/a
• Main Authors: Numata, Kenji, Kobayashi, Daiki, Hosoda, Tomohiro, Saito, Yutaka, Minoura, Ayu, Yamazaki, Satsuki, Fujitani, Shigeki
• Format: Journal Article
• Language: English
• Published: United States Wiley 01.01.2022; John Wiley & Sons, Inc; John Wiley and Sons Inc
• Subjects: Anticoagulants; Asymptomatic; Blood pressure; Chronic illnesses; Cohort analysis; Coronavirus disease 2019; Coronaviruses; COVID-19; dexamethasone; Drug therapy; Dyspnea; Generalized linear models; Glasgow Coma Scale; Hospitals; Intubation; Length of stay; Medical emergencies. Critical care. Intensive care. First aid; Medicine; Original; Original Articles; Patient positioning; prone positioning; RC86-88.9; Regression analysis; respiratory failure; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Steroids; Ventilators; Japan; dexamethasone; respiratory failure; intubation; Coronavirus disease 2019; prone positioning
• ISSN: 2052-8817; 2052-8817
• DOI: 10.1002/ams2.734

Aim Awake prone positioning (PP) in patients with coronavirus disease 2019 (COVID‐19) can improve oxygenation. However, evidence showing that it can prevent intubation is lacking. This study investigated the efficacy of awake PP in patients with COVID‐19 who received remdesivir, dexamethasone, and anticoagulant therapy. Methods This was a two‐center cohort study. Patients admitted to the severe COVID‐19 patient unit were included. The primary outcome was the intubation rate and secondary outcome was length of stay in the severe COVID‐19 unit. After propensity score adjustment, we undertook multivariable regression to calculate the estimates of outcomes between patients who received awake PP and those who did not. Results Overall, 108 patients were included (54 [50.0%] patients each who did and did not undergo awake PP), of whom 25 (23.2%) were intubated (with awake PP, 5 [9.3%] vs. without awake PP, 20 [37.0%]; P < 0.01). The median length of stay in the severe COVID‐19 unit did not significantly differ (with awake PP, 5 days vs. without awake PP, 5.5 days; P = 0.68). After propensity score adjustment, those who received awake PP had a lower intubation rate than those who did not (odds ratio, 0.22; 95% confidence interval, 0.06–0.85; P = 0.03). Length of stay in the severe COVID‐19 patient unit did not differ significantly (adjusted percentage difference, −24.4%; 95% confidence interval, −56.3% to 30.8%; P = 0.32). Conclusion Awake PP could be correlated with intubation rate in patients with COVID‐19 who are receiving remdesivir, dexamethasone, and anticoagulant therapy. This study aimed to investigate the efficacy of awake prone positioning (PP) for patients with coronavirus disease 2019 (COVID‐19) using remdesivir, dexamethasone, and anticoagulation therapy. We undertook a two‐center propensity score‐adjusted cohort study in Japan from July 2020 to February 2021. We showed that awake PP could be correlated with intubation rate in patients with acute respiratory failure and COVID‐19.