Impact of awake prone positioning duration on intubation or mortality in COVID-19 patients with acute respiratory failure: secondary analysis of a randomized clinical trial.

IF 5.5 1区医学 Q1 CRITICAL CARE MEDICINE

Annals of Intensive Care Pub Date : 2025-06-23 DOI:10.1186/s13613-025-01501-8

Qin Sun, Rui Zhang, Junyi Zhang, Jianfeng Xie, Yingzi Huang, Yi Yang, Haibo Qiu, Ling Liu, Hui Chen

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引用次数: 0

Abstract

Background: Compared with shorter awake prone positioning (APP), prolonged APP (≥ 12 h daily) reduces the intubation rate in patients with COVID-19-related acute hypoxemic respiratory failure (AHRF). However, the optimal APP duration is uncertain. In this secondary analysis, we aimed to explore whether a longer APP duration is associated with improved outcomes and to identify the optimal duration of APP.

Methods: Data from a multicenter randomized controlled trial involving nonintubated COVID-19 patients with AHRF were analyzed. Daily APP duration over 7 days after randomization was recorded as the primary exposure in present study. The primary outcome was the time from randomization to APP failure, which was defined as a composite of tracheal intubation or mortality within 28 days. A Cox proportional hazards regression model was employed to elucidate the associations, and the daily duration of APP was treated as time dependent.

Results: A total of 409 patients were randomized in the original trial, and 408 were enrolled in this analysis. Among these patients, 105 (25.7%) experienced APP failure. A longer daily APP duration was associated with a lower risk of APP failure, with a hazard ratio (HR) of 0.93 (95% confidence interval (CI): 0.88-0.98), and the association was significant only during the first three days after randomization. There was a nonlinear relationship between the daily APP duration and the risk of APP failure (P = 0.015 for nonlinearity). Compared with patients whose APP duration ranged from 8 to 12 h per day, patients with less than 8 h of APP per day had a greater risk of APP failure (HR 2.44, 95% CI 1.21-4.92), whereas extending APP beyond 12 h per day did not improve the outcomes further (HR 1.03, 95% CI 0.51-2.10, P = 0.932).

Interpretation: A longer daily APP duration was associated with a reduced risk of APP failure in COVID-19-related AHRF patients, and the optimal APP duration was 8-12 h per day. Clinical trial ClinicalTrials.gov: NCT05677984, Registered January 3, 2023. https://register.

Clinicaltrials: gov/prs/app/action/SelectProtocol?sid=S000CST9&selectaction=Edit&uid=U0000YKY&ts=4&cx=-x0muek.

查看原文本刊更多论文

醒卧位持续时间对COVID-19急性呼吸衰竭患者插管或死亡率的影响：一项随机临床试验的二次分析

背景：与较短的清醒俯卧位（APP）相比，延长APP（每日≥12 h）可降低covid -19相关急性低氧性呼吸衰竭（AHRF）患者的插管率。然而，APP的最佳持续时间是不确定的。在这一次要分析中，我们的目的是探讨更长的APP持续时间是否与改善的结果相关，并确定APP的最佳持续时间。方法：分析来自一项多中心随机对照试验的数据，该试验涉及非插管的COVID-19 AHRF患者。在本研究中，随机化后超过7天的每日APP持续时间被记录为主要暴露。主要终点是从随机分配到APP失败的时间，其定义为28天内气管插管或死亡率的复合。采用Cox比例风险回归模型来阐明相关性，每日APP持续时间视为时间依赖。结果：在原始试验中，共有409名患者被随机分组，408名患者被纳入本分析。其中105例（25.7%）出现APP功能衰竭。较长的每日APP持续时间与较低的APP失败风险相关，其风险比（HR）为0.93(95%可信区间（CI）： 0.88-0.98)，且该关联仅在随机化后的前三天显著。每日APP持续时间与APP失效风险之间存在非线性关系（非线性P = 0.015）。与每天APP持续时间为8 - 12小时的患者相比，每天APP少于8小时的患者APP衰竭的风险更大（HR 2.44, 95% CI 1.21-4.92），而每天APP超过12小时并没有进一步改善结果（HR 1.03, 95% CI 0.51-2.10, P = 0.932）。解释：较长的每日APP持续时间与covid -19相关AHRF患者APP失效风险降低相关，最佳APP持续时间为每天8-12小时。临床试验ClinicalTrials.gov: NCT05677984，注册于2023年1月3日。https://register.Clinicaltrials: gov / prs / app /行动/ SelectProtocol ? sid = S000CST9&selectaction = Edit&uid = U0000YKY&ts = 4残雪= -x0muek。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Intensive Care CRITICAL CARE MEDICINE-

CiteScore

14.20

自引率

3.70%

发文量

107

审稿时长

13 weeks

期刊介绍： Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.