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KMID : 1144420230380030271
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Acute and Critical Care
2023 Volume.38 No. 3 p.271 ~ p.277
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Awake prone positioning for COVID-19 acute hypoxemic respiratory failure in Tunisia
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Khaoula Ben Ismail
Fatma Essafi
Imen Talik
Najla Ben Slimene
Ines Sdiri
Boudour Ben Dhia
Takoua Merhbene
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Abstract
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Background : In this study, we explored whether awake prone position (PP) can impact prognosis of severe hypoxemia coronavirus disease 2019 (COVID-19) patients.
Methods : This was a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. Patients were divided into two groups: group G1, patients who benefited from a vigilant and effective PP (>4 hours minimum/24) and group G2=control group. We compared demographic, clinical, paraclinical and evolutionary data.
Results : Three hundred forty-nine patients were hospitalized during the study period, 273 met the inclusion criteria. PP was performed in 192 patients (70.3%). The two groups were comparable in terms of demographic characteristics, clinical severity and modalities of oxygenation at intensive care unit (ICU) admission. The mean PaO2/FIO2 ratios were 141 and 128 mm Hg, respectively (P=0.07). The computed tomography scan was comparable with a critical >75% in 48.5% (G1) versus 54.2% (G2). The median duration of the daily PP session was 13±7 hours per day. The average duration of spontaneous PP days was 7 days (4?19). Use of invasive ventilation was lower in the G1 group (27% vs. 56%, P=0.002). Healthcare-associated infections were significantly lower in G1 (42.1% vs. 82%, P=0.01). Duration of total mechanical ventilation and length of ICU stay were comparable between the two groups. Mortality was significantly higher in G2 (64% vs. 28%, P=0.02).
Conclusions : Our study confirmed that awake PP can improve prognosis in COVID-19 patients. Randomized controlled trials are needed to confirm this result.
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KEYWORD
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COVID-19, intensive care unit, patient outcomes, prone position, respiratory distress
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