https://doi.org/10.55788/de6b21ec
“We’ve known for many years that in invasively mechanically ventilated patients, prone positioning may improve oxygenation and reduce ventilator-induced lung injury, due to the more homogenous alveolar strain and more uniform alveolar sizes [1],” explained Prof. Jason Weatherald (University of Alberta, Canada). “This helps to improve clinical outcomes.” The effects of prone positioning in COVID-19 are largely unknown. Prof. Weatherald and co-investigators aimed to assess whether awake prone positioning prevents intubation and improves survival in patients with COVID-19. For this purpose, the COVI-PRONE trial (NCT04350723) randomised 400 patients with acute hypoxemic respiratory failure due to COVID-19 1:1 to an awake prone position (8–10 hours/day) or usual care (not instructed to prone) [2]. Endotracheal intubation at 30 days was the primary outcome of the study. The results were published in JAMA [3].
The primary outcome was not met: 34% of the participants in the intervention arm and 41% of the participants in the usual care arm were intubated at 30 days (HR 0.81; 95% CI 0.59–1.12). Likewise, the investigators observed no difference in mortality rates at 60 days between the 2 groups (22% vs 24%). The intervention was safe, with 0% of the participants experiencing a serious adverse event in the intervention arm.
“This trial did not demonstrate a clear effect of awake prone positioning on intubation or other clinical outcomes,” concluded Prof. Weatherald.
- Kallet RH. Respir Care. 2015;60(11):1660–1687.
- Alhazzani W, et al. Awake Prone Positioning in Acute Hypoxemic Respiratory Failure from COVID-19: A Randomized Clinical Trial. ALERT 1, RCT716, ERS International Congress 2022, Barcelona, Spain, 4–6 September.
- Alhazzani W, et al. JAMA. 2022;327(21):2104–2113.
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Table of Contents: ERS 2022
Featured articles
Letter from the Editor
COVID-19: What Is New?
Does vilobelimab reduce mortality in severe COVID-19?
Awake proning not positive in COVID-19
Favipiravir may help patients over 60 years with COVID-19 to recover
Inhaled agent under investigation for COVID-19
Accurate voice-based COVID-19 diagnostic test in development
Novel scoring tool for post-COVID syndrome aids clinicians and researchers
COPD: Therapies and Innovations
Icenticaftor achieves results on top of triple inhalation therapy in COPD
STARR2: A new approach for treating COPD exacerbations
COPD medication not effective in symptomatic smokers with preserved spirometry
Do digital tools improve physical activity in COPD?
Hyperpolarised gas MRI ready for clinical use
All About Asthma
Tezepelumab in asthma: mucus plugging down, lung function up
Digital asthma intervention improves health and reduces costs
Digitally enhanced therapy lowers treatment burden and costs in severe asthma
Mepolizumab beneficial for patients with severe eosinophilic asthma
Progress in Paediatrics
Antibiotics cause increased risk of wheezing in severe RSV bronchiolitis
Inhaled corticosteroids useful in preterms with decreased lung function
Fish oil or vitamin D during pregnancy can prevent croup
Encouraging results of nintedanib in children with fibrosing ILD
Focus on Interventional Pulmonology
Head-to-head: lung volume reduction surgery vs endobronchial valves
Durable effect of endobronchial valves in severe emphysema
Cone beam CT-guided ENB improves detection of pulmonary nodules
Confirmatory mediastinoscopy not needed in resectable NSCLC
Sleep and Breathing Disorders
In the spotlight: Cancer trends in obstructive sleep apnoea
Impact of CPAP on cardiac endpoints in OSA
Sustained hypoxaemia predicts unprovoked VTE in OSA
CPAP therapy in the prevention of cardiovascular risk in patients with OSA
Other Remarkable Research
Excellent results for high-flow nasal cannula oxygen therapy in acute respiratory failure
Antifibrotic therapy may slow down FVC decline in RAILD
Intravenous N-acetylcysteine performs well in hospitalised patients
Men and women respond differently to diesel exhaust
New trends in cystic lung diseases
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