Evidence map›Paper›PMID 33023669›Full record

Observational studyCritical care (London, England)2020

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.

Carlos Ferrando, Ricard Mellado-Artigas, Alfredo Gea, Egoitz Arruti, César Aldecoa, Ramón Adalia, Fernando Ramasco, Pablo Monedero, Emilio Maseda, Gonzalo Tamayo and 7 more

Open access · goldAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Critical care (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 87 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
87citing papers in PubMed, 15 pooled it
23.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

87 citing papers in PubMed, 15 syntheses or guidelines pooled it, 215 citations in OpenAlex.

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27 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 12 institutions in 2 countries.

Carlos FerrandoDepartment of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Villarroel 170, 08036, Barcelona, Spain. cafeoranestesia@gmail.com.ORCID 0000-0002-1907-5323
Ricard Mellado-ArtigasDepartment of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Villarroel 170, 08036, Barcelona, Spain.
Alfredo GeaDepartment of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.
Egoitz ArrutiUbikare Technology, Vizcaya, Spain.
César AldecoaDepartment of Anesthesiology and Critical Care, Hospital Universitario Río Hortega, Valladolid, Spain.
Ramón AdaliaDepartment of Anesthesiology and Critical Care, Hospital del Mar, Barcelona, Spain.
Fernando RamascoDepartment of Anesthesiology and Critical Care, Hospital Universitario La Princesa, Madrid, Spain.
Pablo MonederoDepartment of Anesthesiology and Intensive Care, Clínica Universitaria de Navarra, Pamplona, Spain.
Emilio MasedaDepartment of Anesthesiology and Critical Care, Hospital Universitario La Paz, Madrid, Spain.
Gonzalo TamayoDepartment of Anesthesiology and Critical Care, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain.
María L Hernández-SanzDepartment of Anesthesiology and Critical Care, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain.
Jordi MercadalDepartment of Anesthesiology and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Villarroel 170, 08036, Barcelona, Spain.
Ascensión Martín-GrandeDepartment of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Robert M KacmarekDepartment of Respiratory Care, Massachusetts General Hospital, Boston, MA, USA.
Jesús VillarCIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
Fernando Suárez-SipmannCIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
COVID-19 Spanish ICU Network
Hospital Universitari i Politècnic La Fe · ESHospital de Cruces · ESHospital Universitario Ramón y Cajal · ESConsorci Institut D'Investigacions Biomediques August Pi I Sunyer · ESInstituto de Salud Carlos III · ESClinica Universidad de Navarra · ESHospital Universitario Río Hortega · ESHospital Universitario La Paz · ESUniversidad de Navarra · ESHospital Del Mar · ESHospital Universitario de La Princesa · ESMassachusetts General Hospital · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAwake prone positioning (awake-PP) in non-intubated coronavirus disease 2019 (COVID-19) patients could avoid endotracheal intubation, reduce the use of critical care resources, and improve survival. We aimed to examine whether the combination of high-flow nasal oxygen therapy (HFNO) with awake-PP prevents the need for intubation when compared to HFNO alone.

methodsProspective, multicenter, adjusted observational cohort study in consecutive COVID-19 patients with acute respiratory failure (ARF) receiving respiratory support with HFNO from 12 March to 9 June 2020. Patients were classified as HFNO with or without awake-PP. Logistic models were fitted to predict treatment at baseline using the following variables: age, sex, obesity, non-respiratory Sequential Organ Failure Assessment score, APACHE-II, C-reactive protein, days from symptoms onset to HFNO initiation, respiratory rate, and peripheral oxyhemoglobin saturation. We compared data on demographics, vital signs, laboratory markers, need for invasive mechanical ventilation, days to intubation, ICU length of stay, and ICU mortality between HFNO patients with and without awake-PP.

resultsA total of 1076 patients with COVID-19 ARF were admitted, of which 199 patients received HFNO and were analyzed. Fifty-five (27.6%) were pronated during HFNO; 60 (41%) and 22 (40%) patients from the HFNO and HFNO + awake-PP groups were intubated. The use of awake-PP as an adjunctive therapy to HFNO did not reduce the risk of intubation [RR 0.87 (95% CI 0.53-1.43), p = 0.60]. Patients treated with HFNO + awake-PP showed a trend for delay in intubation compared to HFNO alone [median 1 (interquartile range, IQR 1.0-2.5) vs 2 IQR 1.0-3.0] days (p = 0.055), but awake-PP did not affect 28-day mortality [RR 1.04 (95% CI 0.40-2.72), p = 0.92].

conclusionIn patients with COVID-19 ARF treated with HFNO, the use of awake-PP did not reduce the need for intubation or affect mortality.

Indexed as

Prone PositionWakefulnessAgedCohort StudiesCoronavirus InfectionsCOVID-19FemaleHumansIntubation, IntratrachealMaleMiddle AgedOxygen Inhalation TherapyPandemicsPneumonia, ViralRisk AssessmentAcute respiratory failureCOVID-19Critical careHigh-flow nasal oxygen therapyMechanical ventilationProne positioning

Identifiers

PMID33023669
PMCPMC7537953
OpenAlexW3089736831

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.