A randomised clinical trial of awake prone positioning in COVID-19 suspects with acute hypoxemic respiratory failure.

Background: Awake prone position (APP) has been reported to improve oxygenation in patients with COVID-19 disease and to reduce the requirement for invasive mechanical ventilation for patients requiring support with high flow nasal cannula. There is conflicting data for patients requiring lower-level oxygen support. Research question: Does APP reduce escalation of oxygen support in COVID-19 patients requiring supplementary oxygen?The primary outcome was defined as an escalation of oxygen support from simple supplementary oxygen (NP, HM, NRB) to NIV (CPAP or BiPAP), HFNC or IMV; OR from NIV (CPAP or BiPAP) or HFNC to IMV by day30. Study design: Two center, prospective, non-blind, randomised controlled trial. Patients with confirmed or suspected COVID-19 pneumonia requiring ≥ 5 liters/min oxygen to maintain saturations ≥ 94 % were randomised to either APP or control group. The APP group received a 3-h APP session three times per day for three days. Results: Between 9 May and July 13, 2021, 89 adults were screened and 61 enrolled, 31 to awake prone position and 30 controls. There was no difference in the primary outcome, 7 (22.6 %) patients randomised to APP and 9 (30.0 %) controls required escalation of oxygen support (OR 0.68 (0.22-2.14), P = 0.51). There were no differences in any secondary outcomes, in APP did not improve oxygenation. Interpretation: In COVID-19 patients, the use of APP did not prevent escalation of oxygen support from supplementary to invasive or non-invasive ventilation or improve patient respiratory physiology. Trial registration: NCT04853979 (clinicaltrials.gov).

Evaluación de los resultados de la ventilación con presión continua en las vías respiratorias / Evaluation of the results of ventilation with continuous pressure in the respiratory airways

Se realizó un estudio de intervención sobre los resultados obtenidos con la aplicación de la presión positiva continua en vías aéreas mediante máscara facial en 32 pacientes ingresados con edema pulmonar en el Servicio de Cuidados Intensivos del Hospital Provincial Docente “Saturnino Lora” de Santiago de Cuba, desde abril de 1999 hasta diciembre del 2000. En la casuística predominaron los integrantes del sexo masculino en el grupo de edades de 50 a 59 años y se produjo una disminución de las frecuencias respiratoría y cardíaca, con incremento de la tensión arterial, en ambos casos carentes de significación estadística; pero el aumento del volumen tidal sí resultó altamente significativo. Los resultados hemogasométricos revelaron cambios no sustanciales de PaCO2, Sb y Eb, con marcadas elevaciones del pH, PaO2 y SaO2. Las complicaciones fueron poco frecuentes y de escasa importancia con el proceder (AU)