Palabras clave
Prono vigil
Mortalidad
Ventilación Mecánica Invasiva
Categorías
Cómo citar
Resumen
Introducción: Analizar los efectos del posicionamiento prono vigil en la evolución clínica de adultos hospitalizados por COVID-19. Pacientes y métodos: Estudio de cohorte en el Hospital Hernán Henríquez, Temuco-Chile. Se incluyó a sujetos ingresados entre marzo y septiembre del año 2020 con diagnóstico de COVID-19. Variables de interés principales: El factor de exposición fue el posicionamiento prono vigil y el resultado fue el requerimiento de ventilación mecánica invasiva (VMI) y la mortalidad. Resultados: La cohorte estuvo compuesta por 346 sujetos, con un promedio de 57 años, 52% eran hombres y 37% tenía 2 o más comorbilidades. De la cohorte estudiada, 20% requirió terapia de prono vigil, y entre ellos, el promedio de días en posición prono vigil fue de 3 días, 28% requirió apoyo de VMI con un promedio de uso 14 días. Las características clínicas basales, no mostraron diferencias significativas entre los sujetos que se posicionaron en prono y los que no se sometieron a este tratamiento. Los modelos de regresión logística ajustados por edad, sexo, comorbilidades y uso de cánula nasal de alto flujo (CNAF) mostraron una disminución del riesgo de requerir VM en los sujetos posicionados en prono vigil [Odds Ratio (OR)= 0.362, Intervalo de confianza (IC)= 0.16-0.77, p=0.009]. Existen diferencias clínicamente relevantes en la curva de sobrevida entre aquellos con posicionamiento prono vigil. Sin embargo, el modelo de regresión de Cox ajustado no evidencia diferencias significativas [Hazard Ratio (HR)= 0.63 (IC)= 0.18-217, p=0.46]. Conclusión: El posicionamiento prono vigil está asociado a menores requerimientos de VMI.
Referencias
Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA [Internet]. 2020 Apr 7 [cited 2022 Nov 9];323(13):1239–42. Available from: https://pubmed.ncbi.nlm.nih.gov/32091533/
Langer T, Brioni M, Guzzardella A, Carlesso E, Cabrini L, Castelli G, et al. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients. Crit Care [Internet]. 2021 Dec 1 [cited 2022 May 14];25(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33823862/
Touchon F, Trigui Y, Prud’Homme E, Lefebvre L, Giraud A, Dols AM, et al. Awake prone positioning for hypoxaemic respiratory failure: past, COVID-19 and perspectives. Eur Respir Rev [Internet]. 2021 Jun 30 [cited 2022 Nov 12];30(160). Available from: https://pubmed.ncbi.nlm.nih.gov/33952601/
Guérin C, Reignier J, Richard J-C, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med [Internet]. 2013 Jun 6 [cited 2022 Nov 9];368(23):2159–68. Available from: https://pubmed.ncbi.nlm.nih.gov/23688302/
Sryma PB, Mittal S, Madan K, Mohan A, Tiwari P, Hadda V, et al. Awake prone positioning in non-intubated patients for the management of hypoxemia in COVID-19: A systematic review and meta-analysis. Monaldi Arch Chest Dis [Internet]. 2021 Apr 22 [cited 2022 Oct 20];91(2). Available from: https://www.monaldi-archives.org/index.php/macd/article/view/1623
Sodhi K, Chanchalani G. Awake Proning: Current Evidence and Practical Considerations. Indian J Crit Care Med [Internet]. 2020 [cited 2022 Oct 20];24(12):1236. Available from: /pmc/articles/PMC7775938/
Awad MT, Ghazaleh S, Khader Y, Banifadel M, Nehme C, Sajdeya O, et al. Efficacy of Early Prone Position on Non-Intubated COVID-19 Patients with Respiratory Failure- A Systemic Review and Meta-Analysis. 2021 May;A2493–A2493.
Ehrmann S, Li J, Ibarra-Estrada M, Perez Y, Pavlov I, McNicholas B, et al. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med [Internet]. 2021 Dec 1 [cited 2022 Oct 20];9(12):1387–95. Available from: http://www.thelancet.com/article/S2213260021003568/fulltext
Chua EX, Zahir SMISM, Ng KT, Teoh WY, Hasan MS, Ruslan SRB, et al. Effect of prone versus supine position in COVID-19 patients: A systematic review and meta-analysis. J Clin Anesth [Internet]. 2021 Nov 1 [cited 2022 Oct 20];74:110406. Available from: /pmc/articles/PMC8216875/
Fazzini B, Page A, Pearse R, Puthucheary Z. Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Br J Anaesth [Internet]. 2022 Feb 1 [cited 2022 Nov 12];128(2):352–62. Available from: https://pubmed.ncbi.nlm.nih.gov/34774295/
Sryma PB, Mittal S, Madan K, Mohan A, Tiwari P, Hadda V, et al. Awake prone positioning in non-intubated patients for the management of hypoxemia in COVID-19: A systematic review and meta-analysis. Monaldi Arch chest Dis = Arch Monaldi per le Mal del torace [Internet]. 2021 Apr 22 [cited 2022 Nov 11];91(2). Available from: https://pubmed.ncbi.nlm.nih.gov/33926179/
Fazzini B, Page A, Pearse R, Puthucheary Z. Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis. BJA Br J Anaesth [Internet]. 2022 Feb 1 [cited 2022 Oct 20];128(2):352. Available from: /pmc/articles/PMC8514681/
Ferrando C, Mellado-Artigas R, Gea A, Arruti E, Aldecoa C, Adalia R, et al. Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study. Crit Care [Internet]. 2020 Oct 6 [cited 2022 Nov 12];24(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33023669/
Li J, Luo J, Pavlov I, Perez Y, Tan W, Roca O, et al. Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Lancet Respir Med [Internet]. 2022 Jun 1 [cited 2022 Nov 11];10(6):573–83. Available from: https://pubmed.ncbi.nlm.nih.gov/35305308/
Perez-Nieto OR, Escarraman-Martinez D, Guerrero-Gutierrez MA, Zamarron-Lopez EI, Mancilla-Galindo J, Kammar-García A, et al. Awake prone positioning and oxygen therapy in patients with COVID-19: the APRONOX study. Eur Respir J [Internet]. 2022 Feb 1 [cited 2022 Nov 11];59(2). Available from: https://pubmed.ncbi.nlm.nih.gov/34266942/
Alhazzani W, Parhar KKS, Weatherald J, Al Duhailib Z, Alshahrani M, Al-Fares A, et al. Effect of Awake Prone Positioning on Endotracheal Intubation in Patients With COVID-19 and Acute Respiratory Failure: A Randomized Clinical Trial. JAMA [Internet]. 2022 Jun 7 [cited 2022 Nov 12];327(21):2104–13. Available from: https://pubmed.ncbi.nlm.nih.gov/35569448/
Qian ET, Gatto CL, Amusina O, Dear ML, Hiser W, Buie R, et al. Assessment of Awake Prone Positioning in Hospitalized Adults With COVID-19: A Nonrandomized Controlled Trial. JAMA Intern Med [Internet]. 2022 Jun 1 [cited 2022 Nov 12];182(6):612–21. Available from: https://pubmed.ncbi.nlm.nih.gov/35435937/
Comparison of two respiratory support strategies in critically ill patients admitted for Covid-19: a retrospective monocentric cohort study - Record details - Embase [Internet]. [cited 2022 Nov 13]. Available from: https://ezproxy.ufro.cl:2104/records?subaction=viewrecord& rid=10&page=1&id=L638583123
Ehrmann S, Li J, Ibarra-Estrada M, Perez Y, Pavlov I, McNicholas B, et al. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med [Internet]. 2021 Dec 1 [cited 2022 Nov 12];9(12):1387–95. Available from: https://pubmed.ncbi.nlm.nih.gov/34425070/
Cardona S, Downing J, Alfalasi R, Bzhilyanskaya V, Milzman D, Rehan M, et al. Intubation rate of patients with hypoxia due to COVID-19 treated with awake proning: A meta-analysis. Am J Emerg Med [Internet]. 2021 May 1 [cited 2022 Nov 12];43:88–96. Available from: https://pubmed.ncbi.nlm.nih.gov/33550104/
Fralick M, Colacci M, Munshi L, Venus K, Fidler L, Hussein H, et al. Prone positioning of patients with moderate hypoxaemia due to covid-19: multicentre pragmatic randomised trial (COVID-PRONE). BMJ [Internet]. 2022 [cited 2022 Nov 12];376. Available from: https://pubmed.ncbi.nlm.nih.gov/35321918/
Schmid B, Griesel M, Fischer AL, Romero CS, Metzendorf MI, Weibel S, et al. Awake Prone Positioning, High-Flow Nasal Oxygen and Non-Invasive Ventilation as Non-Invasive Respiratory Strategies in COVID-19 Acute Respiratory Failure: A Systematic Review and Meta-Analysis. J Clin Med. 2022 Jan 1;11(2).
Li C, Reyes SA, Roche BM, Aisenberg GM, Lal AP, Estrada-Y-Martin RM, et al. Impact of Awake Proning in Acute Hypoxemic Respiratory Failure Secondary to COVID-19: A Retrospective Cohort Study. 2021 May;A2524–A2524.
Huang H Bin, Yao Y, Zhu YB, Du B. Awake prone positioning for patients with COVID-19 pneumonia in intensive care unit: A systematic review and meta-analysis. Front Med [Internet]. 2022 Sep 9 [cited 2022 Nov 12];9. Available from: https://pubmed.ncbi.nlm.nih.gov/36160173/
Qin S, Chang W, Peng F, Hu Z, Yang Y. Awake prone position in COVID-19-related acute respiratory failure: a meta-analysis of randomized controlled trials. BMC Pulm Med [Internet]. 2023 Dec 1 [cited 2023 Jun 7];23(1):145. Available from: https://pubmed.ncbi.nlm.nih.gov/37101160/
Peng Q, Yang S, Zhang Y, Zhao W, Hu M, Meng B, et al. Effects of awake prone position vs. usual care on acute hypoxemic respiratory failure in patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials. Front Med [Internet]. 2023 [cited 2023 Jun 7];10. Available from: https://pubmed.ncbi.nlm.nih.gov/37081841/
Myatra SN, Alhazzani W, Belley-Cote E, Møller MH, Arabi YM, Chawla R, et al. Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure: A rapid practice guideline. Acta Anaesthesiol Scand [Internet]. 2023 May 1 [cited 2023 Jun 7];67(5). Available from: https://pubmed.ncbi.nlm.nih.gov/36691710/
Castaniere I, Tonelli R, Tabbì L, Pisani L, Prediletto I, Comellini V, et al. AWAKE PRONE POSITION IN CRITICAL AND SEVERE COVID-19 PATIENTS UNDERGOING NONINVASIVE RESPIRATORY SUPPORT: A RETROSPECTIVE MULTICENTER COHORT STUDY. 2021 Sep 5;PA1094.
Ibarra-estrada M, Vargas-Obieta A, Marin-Rosales M, Aguirre-Díaz S, García-Salcido R, López-Pulgarín J, et al. 19: PRONE POSITIONING IN AWAKE PATIENTS WITH COVID-19-ASSOCIATED RESPIRATORY FAILURE: THE PROCARF TRIAL. Crit Care Med. 2022 Jan;50(1):10–10.
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Derechos de autor 2024 Franco Pavez-Guerrero, Sergio Muñoz-Navarro, Teresa Balboa-Castillo