对 COVID-19 嫌疑人急性低氧性呼吸衰竭患者进行清醒俯卧位随机临床试验

IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL
Tim R.E. Harris , Zain A. Bhutta , Isma Qureshi , Nadir Kharma , Tasleem Raza , Ali Ait Hssain , Ankush Suresh Pathare , Ashwin D'Silva , Mohamad Yahya Khatib , Mohamed Gafar Hussein Mohamedali , Ignacio Miguel Gomez Macineira , Victor Ramon Garcia Hernandez , Jorge Rosales Garcia , Stephen H. Thomas , Sameer A. Pathan
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引用次数: 0

摘要

背景据报道,清醒俯卧位(APP)可改善 COVID-19 疾病患者的氧合情况,并减少需要高流量鼻插管支持的患者对侵入性机械通气的需求。研究问题APP是否能减少需要补充氧气的COVID-19患者对氧气支持的升级?主要结果定义为氧气支持从简单的补充氧气(NP、HM、NRB)升级到NIV(CPAP或BiPAP)、HFNC或IMV;或到第30天时从NIV(CPAP或BiPAP)或HFNC升级到IMV。确诊或疑似 COVID-19 肺炎的患者需要≥ 5 升/分钟的氧气来维持饱和度≥ 94 %,他们被随机分配到 APP 组或对照组。结果在2021年5月9日至7月13日期间,共筛选出89名成人,61人加入,其中31人采用清醒俯卧位,30人采用对照组。主要结果无差异,7 名(22.6%)随机接受 APP 治疗的患者和 9 名(30.0%)对照组患者需要升级氧气支持(OR 0.68 (0.22-2.14),P = 0.51)。在COVID-19患者中,使用APP并不能防止氧支持从辅助通气升级到有创或无创通气,也不能改善患者的呼吸生理状况。试验注册号NCT04853979(clinicaltrials.gov)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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).

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来源期刊
Contemporary Clinical Trials Communications
Contemporary Clinical Trials Communications Pharmacology, Toxicology and Pharmaceutics-Pharmacology
CiteScore
2.70
自引率
6.70%
发文量
146
审稿时长
20 weeks
期刊介绍: Contemporary Clinical Trials Communications is an international peer reviewed open access journal that publishes articles pertaining to all aspects of clinical trials, including, but not limited to, design, conduct, analysis, regulation and ethics. Manuscripts submitted should appeal to a readership drawn from a wide range of disciplines including medicine, life science, pharmaceutical science, biostatistics, epidemiology, computer science, management science, behavioral science, and bioethics. Contemporary Clinical Trials Communications is unique in that it is outside the confines of disease specifications, and it strives to increase the transparency of medical research and reduce publication bias by publishing scientifically valid original research findings irrespective of their perceived importance, significance or impact. Both randomized and non-randomized trials are within the scope of the Journal. Some common topics include trial design rationale and methods, operational methodologies and challenges, and positive and negative trial results. In addition to original research, the Journal also welcomes other types of communications including, but are not limited to, methodology reviews, perspectives and discussions. Through timely dissemination of advances in clinical trials, the goal of Contemporary Clinical Trials Communications is to serve as a platform to enhance the communication and collaboration within the global clinical trials community that ultimately advances this field of research for the benefit of patients.
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