Respiratory failure & ventilation
Mechanical Power Delivered by Noninvasive Ventilation Contributes to Physio-Anatomical and Clinical Responses to Early Versus Late Proning in COVID-19 Pneumonia*
Authors' conclusion
MP delivered by NIV during initial 24 hours predicts clinical outcomes. PP curtails MP, but cumulative hours of NIV with MP greater than or equal to 17.9 J/min delivered before PP initiation attenuate the benefits of PP.
Study context
- Population
- SARS-CoV-2 pneumonia patients with moderate-to-severe acute hypoxemic respiratory failure (PaO2/FiO2 < 200 mm Hg) receiving noninvasive ventilation (NIV), HUMANITAS Gradenigo Sub-ICU, September 2020–February 2021
- Participants
- 138 patients
- Comparison
- Early prone position (PP) + NIV vs late PP + NIV vs supine NIV
- Early PPn = 58
- Late PPn = 26reference
- Supinen = 54
- Outcome
- Endotracheal intubation and death
- Follow-up
- 28 days
Methodological detailsinverse probability of treatment weighted-matched groups, single-centre
- Inverse probability of treatment weighted-matched groups
- Single-centre
Main finding
As reported in the abstract
28-day intubation and death
Early PP vs Late PPHazard ratio (95% CI)
28-day intubation
0.35(0.19–0.69)
28-day death
0.26(0.07–0.67)
Secondary outcomes
Mechanical power (MP) (first 24 hr) as predictor of 28-day intubation (Cox multivariate analysis)
| HR (95% CI) | P value | ||
|---|---|---|---|
| MP (first 24 hr) | 1.70 (1.25–2.09) | P = 0.009 | |
| 0.512Hazard ratio (log scale) |
MP (first 24 hr) as predictor of 28-day death (Cox multivariate analysis)
| HR (95% CI) | P value | ||
|---|---|---|---|
| MP (first 24 hr) | 1.51 (1.19–1.91) | P = 0.007 | |
| 0.512Hazard ratio (log scale) |
MP reduction with PP vs supine position
- PP associated with MP reduction vs supine position
- 35%
Ventilatory ratio (VR), ultrasonographic scores and inflammatory biomarkers · 24 hours of NIV
- Improved in early PP, but not in late PP or supine group
MP (first 24 hr) ≥17.9 J/min and 28-day death
- AUC
- 0.92 (95% CI 0.88-0.96; p < 0.001)
- Cumulative hours of MP ≥17.9 J/min before PP initiation attenuated VR, ultrasonographic and biomarker responses to PP
Original publication
Mechanical Power Delivered by Noninvasive Ventilation Contributes to Physio-Anatomical and Clinical Responses to Early Versus Late Proning in COVID-19 Pneumonia*. Crit Care Med. Published 26 May 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →