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).

Resultados de un nuevo protocolo para el tratamiento de la sepsis / Results of the implementation of a new protocol for the sepsis management

RESUMEN Introducción: la sepsis es una causa importante de hospitalización con una alta tasa de mortalidad. Se produce en el 1-2 % de todas las hospitalizaciones en los Estados Unidos, afecta al menos a 750 000 personas y con un costo de $ 17 mil millones por año. Objetivo: describir el resultado de la implementación del nuevo protocolo para el tratamiento de la sepsis en una unidad de cuidados intensivos. Métodos: se realizó un estudio observacional, descriptivo, retrospectivo y comparativo, de dos series de casos con todos los pacientes (110) en la Unidad de Cuidados Intensivos del Hospital Cubano en Dukhan, Qatar, con diagnóstico de sepsis o shock séptico desde noviembre 2015 a junio 2017. Se dividieron en el grupo A los pacientes con el protocolo habitual y en el B los que recibieron tratamiento según el nuevo protocolo. Resultados: en el grupo B 42 pacientes (70 %) no llegaron al 90 % de cumplimiento de las medidas (aunque estuvieron por encima del 80 %) y un 30 % cumplieron el 90 % o más (p= 0,032). La mayoría de los pacientes fueron egresados vivos (103 para un 93,6 %), independientemente de los protocolos aplicados, pero la mortalidad con el nuevo protocolo fue significativamente menor ya que hubo solo un fallecido en comparación con 6 en el grupo A, p = 0,027. Conclusiones: el cumplimiento del nuevo protocolo de sepsis en Qatar disminuyó significativamente la mortalidad, a pesar de las dificultades para cumplir las directrices en más del 90 %.

ABSTRACT Introduction: sepsis is a major cause of hospitalization with a high mortality rate. It occurs in 1 % to 2 % of all hospitalizations in the United States, affecting at least 750 000 persons with a cost of $17 billion per year. Objective: to describe the implementation results of Qatar Sepsis Guideline in the Intensive Care Unit. Method: an observational descriptive retrospective and comparison study of cases series in 110 patients admitted at the intensive care unit at the Cuban Hospital in Dukhan, Qatar with diagnosis of sepsis and septic shock was done (from November 2015 to June 2017). Results: All patient of the B group were assisted according with the new protocol, 42 patients (70 %) with less than 90 % of compliance of the bundles but they were more than 80 % and 30 % of cases with more than 90 % of compliance of guidelines (p = 0.032). On the other hand the majority of patients were discharged alive, independently of the protocols used (N = 103) to 93.6 %. Conclusion: this study demonstrated that the 90 % or more compliance of Qatar Sepsis Guidelines significantly reduces the mortality; although larger series of cases studies are required.