Zhong Ni, Kaige Wang, Ting Wang, Yuenan Ni, Wei Huang, Ping Zhu, Tao Fan, Ye Wang, Bo Wang, Jun Deng, Zhicheng Qian, Jiasheng Liu, Wenhao Cai, Shanling Xu, Yu Du, Gang Wang, Zongan Liang, Weimin Li, Jianfei Luo, Fengming Luo, Dan Liu
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引用次数: 5
Abstract
Background: Position intervention has been shown to improve oxygenation, but its role in non-invasively ventilated patients with severe COVID-19 has not been assessed. The objective of this study was to investigate the efficacy of early position intervention on non-invasively ventilated patients with severe COVID-19.
Methods: This was a single-center, prospective observational study in consecutive patients with severe COVID-19 managed in a provisional ICU at Renmin Hospital of Wuhan University from 31 January to 15 February 2020. Patients with chest CT showing exudation or consolidation in bilateral peripheral and posterior parts of the lungs were included. Early position intervention (prone or lateral) was commenced for > 4 hours daily for 10 days in these patients, while others received standard care.
Results: The baseline parameters were comparable between the position intervention group (n = 17) and the standard care group (n = 35). Position intervention was well-tolerated and increased cumulative adjusted mean difference of SpO2/FiO2 (409, 95% CI 86 to 733) and ROX index (26, 95% CI 9 to 43) with decreased Borg scale (-9, 95% CI -15 to -3) during the first 7 days. It also facilitated absorption of lung lesions and reduced the proportion of patients with high National Early Warning Score 2 (≥ 7) on days 7 and 14, with a trend toward faster clinical improvement. Virus shedding and length of hospital stay were comparable between the two groups.
Conclusions: This study provides the first evidence for improved oxygenation and lung lesion absorption using early position intervention in non-invasively ventilated patients with severe COVID-19, and warrants further randomized trials.
背景:体位干预已被证明可以改善氧合,但其在重症COVID-19无创通气患者中的作用尚未得到评估。本研究旨在探讨早期体位干预对重症COVID-19无创通气患者的疗效。方法:本研究是一项单中心、前瞻性观察性研究,研究对象为2020年1月31日至2月15日在武汉大学人民医院临时ICU连续收治的重症COVID-19患者。包括胸部CT显示双侧外周和肺后部有渗出或实变的患者。这些患者开始进行早期体位干预(俯卧位或侧卧位),每天4小时,持续10天,而其他患者则接受标准治疗。结果:体位干预组(n = 17)和标准治疗组(n = 35)的基线参数具有可比性。体位干预耐受性良好,在前7天内SpO2/FiO2的累积调整平均差(409,95% CI 86至733)和ROX指数(26,95% CI 9至43)增加,Borg评分(-9,95% CI -15至-3)降低。同时促进了肺部病变的吸收,降低了第7天和第14天国家预警评分2分(≥7分)高的患者比例,临床改善有较快的趋势。两组之间的病毒脱落和住院时间相当。结论:本研究为无创通气重症COVID-19患者早期体位干预改善氧合和肺病变吸收提供了第一个证据,值得进一步的随机试验。
期刊介绍:
Precision Clinical Medicine (PCM) is an international, peer-reviewed, open access journal that provides timely publication of original research articles, case reports, reviews, editorials, and perspectives across the spectrum of precision medicine. The journal's mission is to deliver new theories, methods, and evidence that enhance disease diagnosis, treatment, prevention, and prognosis, thereby establishing a vital communication platform for clinicians and researchers that has the potential to transform medical practice. PCM encompasses all facets of precision medicine, which involves personalized approaches to diagnosis, treatment, and prevention, tailored to individual patients or patient subgroups based on their unique genetic, phenotypic, or psychosocial profiles. The clinical conditions addressed by the journal include a wide range of areas such as cancer, infectious diseases, inherited diseases, complex diseases, and rare diseases.