Evidence map›Paper›PMID 34127046›Full record

Trial reportCritical care (London, England)2021

Awake prone positioning in patients with hypoxemic respiratory failure due to COVID-19: the PROFLO multicenter randomized clinical trial.

Jacob Rosén, Erik von Oelreich, Diddi Fors, Malin Jonsson Fagerlund, Knut Taxbro, Paul Skorup, Ludvig Eby, Francesca Campoccia Jalde, Niclas Johansson, Gustav Bergström and 2 more

Open access · goldAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 70 papers, 18 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
70citing papers in PubMed, 18 pooled it
22.9field-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

70 citing papers in PubMed, 18 syntheses or guidelines pooled it, 171 citations in OpenAlex.

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10 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

12 authors at 4 institutions in 1 country.

Jacob Rosén *Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Entrance 78, 1 floor, 751 85, Uppsala, Sweden. jacob.rosen@surgsci.uu.se.ORCID 0000-0001-9518-5834
Erik von Oelreich *Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
Diddi ForsDepartment of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Entrance 78, 1 floor, 751 85, Uppsala, Sweden.
Malin Jonsson FagerlundPerioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
Knut TaxbroDepartment of Anaesthesiology and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden.
Paul SkorupDepartment of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
Ludvig EbyAcute and Reparative Medicine, Karolinska University Hospital, Solna, Sweden.
Francesca Campoccia JaldePerioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
Niclas JohanssonDepartment of Infectious Diseases, Karolinska University Hospital, Solna, Sweden.
Gustav BergströmDepartment of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
Peter FrykholmDepartment of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Entrance 78, 1 floor, 751 85, Uppsala, Sweden.
PROFLO Study Group
Karolinska University Hospital · SEUppsala University · SEKarolinska Institutet · SERyhov Hospital Jönköping · SE

Funding

Hjärt-Lungfonden 20210061
6 · The paper itself

Abstract

backgroundThe effect of awake prone positioning on intubation rates is not established. The aim of this trial was to investigate if a protocol for awake prone positioning reduces the rate of endotracheal intubation compared with standard care among patients with moderate to severe hypoxemic respiratory failure due to COVID-19.

methodsWe conducted a multicenter randomized clinical trial. Adult patients with confirmed COVID-19, high-flow nasal oxygen or noninvasive ventilation for respiratory support and a PaO

resultsOf 141 patients assessed for eligibility, 75 were randomized of whom 39 were allocated to the control group and 36 to the prone group. Within 30 days after enrollment, 13 patients (33%) were intubated in the control group versus 12 patients (33%) in the prone group (HR 1.01 (95% CI 0.46-2.21), P = 0.99). Median prone duration was 3.4 h [IQR 1.8-8.4] in the control group compared with 9.0 h per day [IQR 4.4-10.6] in the prone group (P = 0.014). Nine patients (23%) in the control group had pressure sores compared with two patients (6%) in the prone group (difference - 18% (95% CI - 2 to - 33%); P = 0.032). There were no other differences in secondary outcomes between groups.

conclusionsThe implemented protocol for awake prone positioning increased duration of prone positioning, but did not reduce the rate of intubation in patients with hypoxemic respiratory failure due to COVID-19 compared to standard care.

trial registrationISRCTN54917435. Registered 15 June 2020 ( https://doi.org/10.1186/ISRCTN54917435 ).

Indexed as

Prone PositionAdultCOVID-19HumansIntensive Care UnitsIntubation, IntratrachealMaleMiddle AgedOxygen Inhalation TherapyPatient PositioningRespiratory InsufficiencyWakefulnessAwake prone positioningCOVID-19Critical careHigh-flow nasal oxygenIntensive careIntubation ratesMechanical ventilationNoninvasive ventilationRespiratory failure

Identifiers

PMID34127046
PMCPMC8200797
OpenAlexW3161997411

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.