Observational studyIntensive care medicine2025
Effectiveness of bundle of care on tolerance of awake-prone positioning in patients with acute respiratory failure. A multicenter observational study.
Observational study in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05178212 (Characteristics and Outcomes of Patients With COVID-19-related Acute Respiratory Failure Treated With High-flow Nasal Oxygen and Awake-prone Position), which is not on this map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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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.
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.
Characteristics and Outcomes of Patients With COVID-19-related Acute Respiratory Failure Treated With High-flow Nasal Oxygen and Awake-prone Position
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Awake prone positioning reduces mortality, intubation, and hospital stay in acute hypoxemic respiratory failure: a systematic review and meta-analysis of 6,164 patients.BMC anesthesiology · 2026Pooled it
- Association of awake prone positioning with clinical outcomes in severe immune checkpoint inhibitor-associated pneumonitis with acute hypoxemic respiratory failure: a propensity-matched retrospective cohort study.Frontiers in medicine · 2026Article
- EIT-guided chest physiotherapy for airway clearance during awake prone ventilation in ARDS: a randomized controlled trial.Journal of thoracic disease · 2025Article
- [Awake prone position in critically ill patients-a practice recommendation].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Review
- A predictive model for early intubation in patients with COVID-19-induced acute hypoxemic respiratory failure under awake prone position.Annals of intensive care · 2025Article
- Reconsidering methodological choices and future research avenues in awake prone positioning studies.Intensive care medicine · 2025Article
- Reconsidering methodological choices and future research avenues in awake prone positioning studies. Author's reply.Intensive care medicine · 2025Article
- Optimizing non-intubated respiratory support in COVID-19: evaluating the impact of bundle of care strategy on awake prone positioning tolerance. Author's reply.Intensive care medicine · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThis study aimed to assess the impact of a bundle of care strategy on the duration of awake prone positioning (AW-PP) and other key clinical outcomes in patients with acute respiratory failure (ARF) who require high-flow nasal oxygen (HFNO).
methodsIn this secondary analysis of a prospective, multicenter cohort study, we included patients admitted with COVID-19-related ARF who required HFNO. The protocol encouraged AW-PP for as long as possible. The main exposure was a bundle of care including light sedation, monitoring, and information to patients about the strategy (bundle) compared to no bundle (control). The primary outcome was the duration of AW-PP (hours/day), while secondary outcomes included endotracheal intubation and in-hospital mortality. Directed acyclic graphs (DAGs) were employed to identify variables related to both exposure and outcomes. Four models were used to evaluate exposure-outcome associations: inverse probability of treatment weighting (IPTW), "double-robust" approximation (DR), traditional regression (TR), and mixed-effects model (MEM).
resultsOut of 499 patients, 197 were exposed to bundle, and 302 did not. The exposure group had a median (IQR) AW-PP duration of 16 (10-18) hours/day, compared to 10 (7-14) hours/day in the control group. Regression coefficients (95% CI) were 3.39 (1.67-5.11), 3.35 (1.55-5.14), 3.95 (2.63-5.28), and 3.72 (2.5-4.94) for IPTW, DR, TR and MEM, respectively. The odds ratios (95% CI) for intubation were 0.34 (0.15-0.76), 0.23 (0.10-0.50), 0.42 (0.23-0.77), and 0.48 (0.16-0.49), and for in-hospital mortality were 0.38 (0.11-1.27), 0.43 (0.14-1.26), 0.47 (0.22-0.91), and 0.46 (0.12-1.43) in the respective models.
conclusionIn the evaluated population of patients with COVID-19-related ARF, implementing a bundle-of-care strategy was associated with a longer AW-PP exposure and a reduced risk of endotracheal intubation. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov. Identifier NCT05178212. Date of registration: January 5th, 2022. STUDY TYPE: Observational.
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Registered trials
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.