Scholarlink

Purpose <p>This 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).</p> Methods <p>In 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).</p> Results <p>Out 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.</p> Conclusion <p>In 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.</p> Trial Registration Number <p>ClinicalTrials.gov. Identifier NCT05178212. Date of registration: January 5th, 2022. Study Type: Observational.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Effectiveness of bundle of care on tolerance of awake-prone positioning in patients with acute respiratory failure. A multicenter observational study

  • 期刊论文

  • 发表日期：

    2025年2月17日

查看全文
  • Matías Olmos,
  • Nora Fuentes,
  • Marina Busico,
  • Adrian Gallardo,
  • Alejandra Vitali,
  • Eduardo L. V. Costa,
  • Marcelo B. P. Amato,
  • Alejandro Bruhn,
  • Mariano Esperatti,
  • Hiromi Kakisu,
  • Jorgelina Quintana,
  • Javier Osatnik,
  • Pablo Comimiani,
  • Santiago Nicolas Saavedra,
  • Ana Inés Lagazio,
  • Nahuel Esteban Romano,
  • Agustin Matarrese,
  • Mariela Adriana Mogaadouro,
  • Claudia Navarro Moreno,
  • Greta Dennise Rebaza Niquin,
  • Anabel Miranda Tirado,
  • María Constanza Viñas,
  • Juan Manuel Pintos,
  • Maria Eugenia Gonzalez,
  • Marisol Mariela Laiz,
  • Jose Garcia Urrutia,
  • Micaela Ruiz Seifert,
  • Emilce Mastroberti,
  • Ana Elizabeth Grimbee,
  • Leonel Stein,
  • Ariel Juan Latronico,
  • Silvia Laura Menéndez

摘要

Purpose

This 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).

Methods

In 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).

Results

Out 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.

Conclusion

In 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.