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The aim of this observational study is to evaluate the physiological and clinical effects of prone position in awake patients with respiratory failure due to COVID-19.
The purpose of this study is to investigate the role of prone positioning in SARS-CoV-2 infected patients that are not intubated. Prone patient placement during invasive mechanical ventilation is a widespread practice in the management of severe ARDS. However, few attempts have been made to implement the prone position in patients that spontaneously ventilate with supplemental oxygen. Considering that it is a procedure that does not require additional equipment and does not represent an additional cost for its implementation, it becomes a valuable tool in the context of COVID-19 where intubation is associated with high mortality. The investigators will analyze a cohort of patients with COVID-19 and respiratory failure managed with prone position as indicated by the attending physician and register physiological variables and clinical outcomes (intubation and death).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Prone position | Prone position per institutional protocol and as indicated by the treating physician |
| |
| No prone position | The control group will not be in prone position |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Prone position | Other | Prone position as indicated by the treating physician as specified in the institutional protocol |
|
| Measure | Description | Time Frame |
|---|---|---|
| Therapeutic failure | Defined by death or intubation or use of non-invasive ventilation | At 14 days |
| Mortality | Number of patients that die | At day 28 |
| Length of hospital stay | Number of days spent by the patients at the hospital | At 28 days |
| Days requiring high flow nasal oxygen | Number of days the patients require high flow nasal oxygen therapy | At 28 days |
| Days requiring supplemental oxygen | Number of days the patients require supplementary oxygen | At 28 days |
| Displacement of invasive devices during position changes | Unintentional displacement or removal of Invasive devices including : central and peripheric vascular catheters, urinary catheter and chest tubes | At 28 days |
| Occurrence of pressure ulcers on the anterior surface of the body | Number of patients that develope pressure ulcers on the anterior surface of the body | At 28 days |
| Measure | Description | Time Frame |
|---|---|---|
| Respiratory superinfection | Certified by a respiratory tract sample and culture | At 28 days |
| Delirium | Defined by the Confusion Assessment Method (CAM) |
| Measure | Description | Time Frame |
|---|---|---|
| Dyspnea | Using a scale from 1 to 10 (from 1 no dyspnea to 10 maximum dyspnea) | At 28 days |
| Comfort with the position | Using a scale from 1 to 4 (1 is very comfortable and 4 is very uncomfortable) |
Inclusion Criteria:
Exclusion Criteria:
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Hospitalized COVID-19 adult patients with acute respiratory failure
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital Clinico Red de Salud UC - Christus | Santiago | Santiago Metropolitan | Chile |
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| ID | Term |
|---|---|
| D000086382 | COVID-19 |
| D055371 | Acute Lung Injury |
| D012131 | Respiratory Insufficiency |
| ID | Term |
|---|---|
| D011024 | Pneumonia, Viral |
| D011014 | Pneumonia |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
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| ID | Term |
|---|---|
| D016684 | Prone Position |
| ID | Term |
|---|---|
| D011187 | Posture |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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| At 28 days |
| Caloric intake | Daily number of ingested calories (in kilocalories) by the patients is recorded | At 28 days |
| Proteic intake | Daily number of ingested proteins (in grams) by the patients is recorded | At 28 days |
| At 28 days |
| Oxygen saturation | Using PAFI (PAFI: Index calculated by Pressure of Arterial Oxygen / Inspired Fraction of Oxygen) | At 28 days |
| Oxygen saturation | Using SAFI (SAFI: Index calculated by Oxygen Saturation by Pulse Oximetry / Inspired Fraction of Oxygen) | At 28 days |
| D014777 |
| Virus Diseases |
| D018352 | Coronavirus Infections |
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D012327 | RNA Virus Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D055370 | Lung Injury |
| D012120 | Respiration Disorders |