The widespread application and interest in awake prone positioning stems from its ease and availability and its ability to enhance patients' oxygenation. Nevertheless, due to the absence of consensus over the regimen of awake prone positioning, the efficacy of awake prone positioning remains uncertain. To explore the optimal regimen for awake prone positioning, including the timing of initiation, ideal daily duration, and strategies for improving patient comfort and encouraging adherence. Retrospective observational study. Two university-affiliated hospitals in Shanghai. Between December 2022 and February 2023, a total of 475 patients with COVID-19-related pneumonia who received awake prone positioning were observed. The data were collected from the hospital's electronic medical record system. The differentiation efficiency of peripheral blood oxygen saturation [SpO]:fractional oxygen concentration in inspired air [FiO] ratio at first awake prone positioning for different outcomes was tested by the area under the receiver operating characteristic curve. The Cox proportional hazard regression model was used to analyze the relationship between time to occurrence of 28-day outcomes and collected variables. Kaplan–Meier curves were plotted with the percentage of 28-day outcomes according to the SpO:FiO ratio at first awake prone positioning after controlling covariates through Cox regression. The best efficiency in predicting patient outcomes was achieved when the cutoff SpO:FiO ratio at first awake prone positioning was 200. Patients with a reduced SpO:FiO ratio (≤200) experienced more adverse respiratory outcomes (RR = 5.42, 95%CI [3.35, 8.76], p < 0·001) and higher mortality (RR = 16.64, 95%CI [5.53, 50.13], p < 0.001). Patients with a SpO:FiO ratio of ≥200 at first awake prone positioning, longer duration between first awake prone positioning and admission, more awake prone positioning days, and better awake prone positioning completion were significantly protected from 28-day adverse respiratory outcomes and mortality. Initiating awake prone positioning with a SpO:FiO ratio exceeding 200, increasing the number of awake prone positioning days, prolonging the time between first awake prone positioning and admission, and achieving better completion of awake prone positioning were found to be significantly associated with reduced adverse respiratory outcomes and mortality. ; No.: ; URL: .

中文翻译：

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Covid-19 患者清醒俯卧位的最佳时机：来自两个中心的观察性研究的见解

清醒俯卧位的广泛应用和兴趣源于其简便性和可用性以及增强患者氧合的能力。然而，由于对清醒俯卧位的治疗方案缺乏共识，清醒俯卧位的疗效仍不确定。探索清醒俯卧位的最佳方案，包括开始时间、理想的每日持续时间以及提高患者舒适度和鼓励坚持的策略。回顾性观察研究。上海的两家大学附属医院。2022年12月至2023年2月期间，共观察了475名接受清醒俯卧位的COVID-19相关肺炎患者。数据是从医院的电子病历系统收集的。通过受试者工作特征曲线下面积测试不同结果下首次清醒俯卧位时外周血氧饱和度[SpO]与吸入空气中氧浓度分数[FiO]的区分效率。使用 Cox 比例风险回归模型分析 28 天结果发生的时间与收集的变量之间的关系。通过 Cox 回归控制协变量后，根据第一次清醒俯卧位时的 SpO:FiO 比率，绘制 Kaplan-Meier 曲线与 28 天结果的百分比。当第一次清醒俯卧位时的截止 SpO:FiO 比率为 200 时，预测患者结局的效率最高。SpO:FiO 比率降低（≤200）的患者会经历更不良的呼吸结局（RR = 5.42，95%CI [ 3.35, 8.76], p < 0·001) 和更高的死亡率 (RR = 16.64, 95% CI [5.53, 50.13], p < 0.001)。首次清醒俯卧位时 SpO:FiO 比率≥200、首次清醒俯卧位与入院之间的持续时间更长、清醒俯卧位天数更长、清醒俯卧位完成情况更好的患者可显着避免 28 天不良呼吸结局和死亡率。研究发现，以 SpO:FiO 比率超过 200 开始清醒俯卧位、增加清醒俯卧位天数、延长首次清醒俯卧位与入院之间的时间以及更好地完成清醒俯卧位与减少不良反应显着相关。呼吸系统结果和死亡率。; 不。： ; 网址： .