{"id":19075,"date":"2020-07-16T05:17:09","date_gmt":"2020-07-15T21:17:09","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=19075"},"modified":"2020-07-22T18:54:37","modified_gmt":"2020-07-22T10:54:37","slug":"lancet-respir-med%e5%9c%a8%e7%ba%bf%e5%8f%91%e8%a1%a8%ef%bc%9a%e6%96%b0%e5%86%a0%e7%97%85%e6%af%92%e6%84%9f%e6%9f%93%e4%bc%b4%e6%80%a5%e6%80%a7%e5%91%bc%e5%90%b8%e5%8a%9f%e8%83%bd%e8%a1%b0%e7%ab%ad","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=19075","title":{"rendered":"[Lancet Respir Med\u5728\u7ebf\u53d1\u8868]\uff1a\u65b0\u51a0\u75c5\u6bd2\u611f\u67d3\u4f34\u6025\u6027\u547c\u5438\u529f\u80fd\u8870\u7aed\u7684\u672a\u63d2\u7ba1\u60a3\u8005\u5b9e\u65bd\u4fef\u5367\u4f4d\u7684\u53ef\u884c\u6027\u4e0e\u751f\u7406\u4f5c\u7528\uff1a\u4e00\u9879\u524d\u77bb\u961f\u5217\u7814\u7a76"},"content":{"rendered":"\n

ARTICLES|ONLINE FIRST<\/a><\/p>\n\n\n\n

Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study<\/h1>\n\n\n\n

Anna Coppo, Giacomo Bellani, Dario Winterton, et al<\/h3>\n\n\n\n

Lancet Respir Med Published:June 19, 2020 DOI:https:\/\/doi.org\/10.1016\/S2213-2600(20)30268-X<\/a><\/h3>\n\n\n\n

Summary<\/h2>\n\n\n\n

Background<\/h3>\n\n\n\n

The COVID-19 pandemic is challenging advanced health systems, which are dealing with an overwhelming number of patients in need of intensive care for respiratory failure, often requiring intubation. Prone positioning in intubated patients is known to reduce mortality in moderate-to-severe acute respiratory distress syndrome. We aimed to investigate feasibility and effect on gas exchange of prone positioning in awake, non-intubated patients with COVID-19-related pneumonia.<\/p>\n\n\n\n

Methods<\/h3>\n\n\n\n

In this prospective, feasibility, cohort study, patients aged 18\u201375 years with a confirmed diagnosis of COVID-19-related pneumonia receiving supplemental oxygen or non-invasive continuous positive airway pressure were recruited from San Gerardo Hospital, Monza, Italy. We collected baseline data on demographics, anthropometrics, arterial blood gas, and ventilation parameters. After baseline data collection, patients were helped into the prone position, which was maintained for a minimum duration of 3 h. Clinical data were re-collected 10 min after prone positioning and 1 h after returning to the supine position. The main study outcome was the variation in oxygenation (partial pressure of oxygen [PaO2<\/sub>]\/fractional concentration of oxygen in inspired air [FiO2<\/sub>]) between baseline and resupination, as an index of pulmonary recruitment. This study is registered on ClinicalTrials.gov<\/a>, NCT04365959<\/a>, and is now complete.<\/p>\n\n\n\n

Findings<\/h3>\n\n\n\n

Between March 20 and April 9, 2020, we enrolled 56 patients, of whom 44 (79%) were male; the mean age was 57\u00b74 years (SD 7\u00b74) and the mean BMI was 27\u00b75 kg\/m2<\/sup> (3\u00b77). Prone positioning was feasible (ie, maintained for at least 3 h) in 47 patients (83\u00b79% [95% CI 71\u00b77 to 92\u00b74]). Oxygenation substantially improved from supine to prone positioning (PaO2<\/sub>\/FiO2<\/sub> ratio 180\u00b75 mm Hg [SD 76\u00b76] in supine position vs<\/em> 285\u00b75 mm Hg [112\u00b79] in prone position; p<0\u00b70001). After resupination, improved oxygenation was maintained in 23 patients (50\u00b70% [95% CI 34\u00b79\u201365\u00b71]; ie, responders); however, this improvement was on average not significant compared with before prone positioning (PaO2<\/sub>\/FiO2<\/sub> ratio 192\u00b79 mm Hg [100\u00b79] 1 h after resupination; p=0\u00b729). Patients who maintained increased oxygenation had increased levels of inflammatory markers (C-reactive protein: 12\u00b77 mg\/L [SD 6\u00b79] in responders vs<\/em> 8\u00b74 mg\/L [6\u00b72] in non-responders; and platelets: 241\u00b71\u2008\u00d7\u2008103<\/sup>\/\u03bcL [101\u00b79] vs<\/em> 319\u00b78\u2008\u00d7\u2008103<\/sup>\/\u03bcL [120\u00b76]) and shorter time between admission to hospital and prone positioning (2\u00b77 days [SD 2\u00b71] in responders vs<\/em> 4\u00b76 days [3\u00b77] in non-responders) than did those for whom improved oxygenation was not maintained. 13 (28%) of 46 patients were eventually intubated, seven (30%) of 23 responders and six (26%) of 23 non-responders (p=0\u00b774). Five patients died during follow-up due to underlying disease, unrelated to study procedure.<\/p>\n\n\n\n

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Interpretation<\/h3>\n\n\n\n

Prone positioning was feasible and effective in rapidly ameliorating blood oxygenation in awake patients with COVID-19-related pneumonia requiring oxygen supplementation. The effect was maintained after resupination in half of the patients. Further studies are warranted to ascertain the potential benefit of this technique in improving final respiratory and global outcomes.<\/p>\n\n\n\n

Funding<\/h3>\n\n\n\n

University of Milan-Bicocca.<\/p>\n","protected":false},"excerpt":{"rendered":"

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