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Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience.

Identifieur interne : 000194 ( Main/Exploration ); précédent : 000193; suivant : 000195

Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience.

Auteurs : Rob J. Hallifax [Royaume-Uni] ; Benedict Ml Porter [Royaume-Uni] ; Patrick Jd Elder [Royaume-Uni] ; Sarah B. Evans [Royaume-Uni] ; Chris D. Turnbull [Royaume-Uni] ; Gareth Hynes [Royaume-Uni] ; Rachel Lardner [Royaume-Uni] ; Kirsty Archer [Royaume-Uni] ; Henry V. Bettinson [Royaume-Uni] ; Annabel H. Nickol [Royaume-Uni] ; William G. Flight [Royaume-Uni] ; Stephen J. Chapman [Royaume-Uni] ; Maxine Hardinge [Royaume-Uni] ; Rachel K. Hoyles [Royaume-Uni] ; Peter Saunders [Royaume-Uni] ; Anny Sykes [Royaume-Uni] ; John M. Wrightson [Royaume-Uni] ; Alastair Moore [Royaume-Uni] ; Ling-Pei Ho [Royaume-Uni] ; Emily Fraser [Royaume-Uni] ; Ian D. Pavord [Royaume-Uni] ; Nicholas P. Talbot [Royaume-Uni] ; Mona Bafadhel [Royaume-Uni] ; Nayia Petousi [Royaume-Uni] ; Najib M. Rahman [Royaume-Uni]

Source :

RBID : pubmed:32928787

Descripteurs français

English descriptors

Abstract

The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.

DOI: 10.1136/bmjresp-2020-000678
PubMed: 32928787
PubMed Central: PMC7490910


Affiliations:


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<name sortKey="Ho, Ling Pei" sort="Ho, Ling Pei" uniqKey="Ho L" first="Ling-Pei" last="Ho">Ling-Pei Ho</name>
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<name sortKey="Fraser, Emily" sort="Fraser, Emily" uniqKey="Fraser E" first="Emily" last="Fraser">Emily Fraser</name>
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<term>Aged (MeSH)</term>
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<term>Betacoronavirus (MeSH)</term>
<term>Continuous Positive Airway Pressure (methods)</term>
<term>Coronavirus Infections (mortality)</term>
<term>Coronavirus Infections (therapy)</term>
<term>Disease Progression (MeSH)</term>
<term>Female (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Noninvasive Ventilation (methods)</term>
<term>Odds Ratio (MeSH)</term>
<term>Oxygen Inhalation Therapy (methods)</term>
<term>Pandemics (MeSH)</term>
<term>Patient Positioning (methods)</term>
<term>Pneumonia, Viral (mortality)</term>
<term>Pneumonia, Viral (therapy)</term>
<term>Prone Position (MeSH)</term>
<term>Retrospective Studies (MeSH)</term>
<term>Treatment Outcome (MeSH)</term>
<term>United Kingdom (MeSH)</term>
<term>Wakefulness (MeSH)</term>
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<term>Adulte d'âge moyen (MeSH)</term>
<term>Betacoronavirus (MeSH)</term>
<term>Décubitus ventral (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Infections à coronavirus (mortalité)</term>
<term>Infections à coronavirus (thérapie)</term>
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<term>Pneumopathie virale (thérapie)</term>
<term>Positionnement du patient (méthodes)</term>
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<term>Ventilation en pression positive continue (méthodes)</term>
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<term>Oxygénothérapie</term>
<term>Positionnement du patient</term>
<term>Ventilation en pression positive continue</term>
<term>Ventilation non effractive</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en">
<term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
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<term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
</keywords>
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<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Betacoronavirus</term>
<term>Disease Progression</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Odds Ratio</term>
<term>Pandemics</term>
<term>Prone Position</term>
<term>Retrospective Studies</term>
<term>Treatment Outcome</term>
<term>Wakefulness</term>
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<term>Adulte d'âge moyen</term>
<term>Betacoronavirus</term>
<term>Décubitus ventral</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Odds ratio</term>
<term>Pandémies</term>
<term>Royaume-Uni</term>
<term>Résultat thérapeutique</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Vigilance</term>
<term>Études rétrospectives</term>
<term>Évolution de la maladie</term>
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<front>
<div type="abstract" xml:lang="en">The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.</div>
</front>
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<DateCompleted>
<Year>2020</Year>
<Month>09</Month>
<Day>24</Day>
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<Month>10</Month>
<Day>01</Day>
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<Issue>1</Issue>
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<Year>2020</Year>
<Month>09</Month>
</PubDate>
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<Title>BMJ open respiratory research</Title>
<ISOAbbreviation>BMJ Open Respir Res</ISOAbbreviation>
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<ArticleTitle>Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience.</ArticleTitle>
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<Abstract>
<AbstractText>The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.</AbstractText>
<CopyrightInformation>© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation>
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<AffiliationInfo>
<Affiliation>Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK.</Affiliation>
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<name sortKey="Bettinson, Henry V" sort="Bettinson, Henry V" uniqKey="Bettinson H" first="Henry V" last="Bettinson">Henry V. Bettinson</name>
<name sortKey="Chapman, Stephen J" sort="Chapman, Stephen J" uniqKey="Chapman S" first="Stephen J" last="Chapman">Stephen J. Chapman</name>
<name sortKey="Elder, Patrick Jd" sort="Elder, Patrick Jd" uniqKey="Elder P" first="Patrick Jd" last="Elder">Patrick Jd Elder</name>
<name sortKey="Evans, Sarah B" sort="Evans, Sarah B" uniqKey="Evans S" first="Sarah B" last="Evans">Sarah B. Evans</name>
<name sortKey="Flight, William G" sort="Flight, William G" uniqKey="Flight W" first="William G" last="Flight">William G. Flight</name>
<name sortKey="Fraser, Emily" sort="Fraser, Emily" uniqKey="Fraser E" first="Emily" last="Fraser">Emily Fraser</name>
<name sortKey="Hallifax, Rob J" sort="Hallifax, Rob J" uniqKey="Hallifax R" first="Rob J" last="Hallifax">Rob J. Hallifax</name>
<name sortKey="Hardinge, Maxine" sort="Hardinge, Maxine" uniqKey="Hardinge M" first="Maxine" last="Hardinge">Maxine Hardinge</name>
<name sortKey="Ho, Ling Pei" sort="Ho, Ling Pei" uniqKey="Ho L" first="Ling-Pei" last="Ho">Ling-Pei Ho</name>
<name sortKey="Ho, Ling Pei" sort="Ho, Ling Pei" uniqKey="Ho L" first="Ling-Pei" last="Ho">Ling-Pei Ho</name>
<name sortKey="Hoyles, Rachel K" sort="Hoyles, Rachel K" uniqKey="Hoyles R" first="Rachel K" last="Hoyles">Rachel K. Hoyles</name>
<name sortKey="Hynes, Gareth" sort="Hynes, Gareth" uniqKey="Hynes G" first="Gareth" last="Hynes">Gareth Hynes</name>
<name sortKey="Lardner, Rachel" sort="Lardner, Rachel" uniqKey="Lardner R" first="Rachel" last="Lardner">Rachel Lardner</name>
<name sortKey="Lardner, Rachel" sort="Lardner, Rachel" uniqKey="Lardner R" first="Rachel" last="Lardner">Rachel Lardner</name>
<name sortKey="Moore, Alastair" sort="Moore, Alastair" uniqKey="Moore A" first="Alastair" last="Moore">Alastair Moore</name>
<name sortKey="Nickol, Annabel H" sort="Nickol, Annabel H" uniqKey="Nickol A" first="Annabel H" last="Nickol">Annabel H. Nickol</name>
<name sortKey="Pavord, Ian D" sort="Pavord, Ian D" uniqKey="Pavord I" first="Ian D" last="Pavord">Ian D. Pavord</name>
<name sortKey="Petousi, Nayia" sort="Petousi, Nayia" uniqKey="Petousi N" first="Nayia" last="Petousi">Nayia Petousi</name>
<name sortKey="Petousi, Nayia" sort="Petousi, Nayia" uniqKey="Petousi N" first="Nayia" last="Petousi">Nayia Petousi</name>
<name sortKey="Porter, Benedict Ml" sort="Porter, Benedict Ml" uniqKey="Porter B" first="Benedict Ml" last="Porter">Benedict Ml Porter</name>
<name sortKey="Rahman, Najib M" sort="Rahman, Najib M" uniqKey="Rahman N" first="Najib M" last="Rahman">Najib M. Rahman</name>
<name sortKey="Rahman, Najib M" sort="Rahman, Najib M" uniqKey="Rahman N" first="Najib M" last="Rahman">Najib M. Rahman</name>
<name sortKey="Saunders, Peter" sort="Saunders, Peter" uniqKey="Saunders P" first="Peter" last="Saunders">Peter Saunders</name>
<name sortKey="Sykes, Anny" sort="Sykes, Anny" uniqKey="Sykes A" first="Anny" last="Sykes">Anny Sykes</name>
<name sortKey="Talbot, Nicholas P" sort="Talbot, Nicholas P" uniqKey="Talbot N" first="Nicholas P" last="Talbot">Nicholas P. Talbot</name>
<name sortKey="Talbot, Nicholas P" sort="Talbot, Nicholas P" uniqKey="Talbot N" first="Nicholas P" last="Talbot">Nicholas P. Talbot</name>
<name sortKey="Turnbull, Chris D" sort="Turnbull, Chris D" uniqKey="Turnbull C" first="Chris D" last="Turnbull">Chris D. Turnbull</name>
<name sortKey="Turnbull, Chris D" sort="Turnbull, Chris D" uniqKey="Turnbull C" first="Chris D" last="Turnbull">Chris D. Turnbull</name>
<name sortKey="Wrightson, John M" sort="Wrightson, John M" uniqKey="Wrightson J" first="John M" last="Wrightson">John M. Wrightson</name>
</country>
</tree>
</affiliations>
</record>

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