Awake prone positioning (APP) is widely used in the management of patients with coronavirus disease (COVID-19). The primary objective of this study was to compare the outcome of COVID-19 patients who received early versus late APP. Post hoc analysis of data collected for a randomized controlled trial (ClinicalTrials.gov NCT04325906). Adult patients with acute hypoxemic respiratory failure secondary to COVID-19 who received APP for at least one hour were included. Early prone positioning was defined as APP initiated within 24 h of high-flow nasal cannula (HFNC) start. Primary outcomes were 28-day mortality and intubation rate. We included 125 patients (79 male) with a mean age of 62 years. Of them, 92 (73.6%) received early APP and 33 (26.4%) received late APP. Median time from HFNC initiation to APP was 2.25 (0.8–12.82) vs 36.35 (30.2–75.23) hours in the early and late APP group (p < 0.0001), respectively. Average APP duration was 5.07 (2.0–9.05) and 3.0 (1.09–5.64) hours per day in early and late APP group (p < 0.0001), respectively. The early APP group had lower mortality compared to the late APP group (26% vs 45%, p = 0.039), but no difference was found in intubation rate. Advanced age (OR 1.12 [95% CI 1.0–1.95], p = 0.001), intubation (OR 10.65 [95% CI 2.77–40.91], p = 0.001), longer time to initiate APP (OR 1.02 [95% CI 1.0–1.04], p = 0.047) and hydrocortisone use (OR 6.2 [95% CI 1.23–31.1], p = 0.027) were associated with increased mortality. Early initiation (< 24 h of HFNC use) of APP in acute hypoxemic respiratory failure secondary to COVID-19 improves 28-day survival. Trial registration ClinicalTrials.gov NCT04325906.

中文翻译：

---

未插管的 COVID-19 患者的早醒与晚醒俯卧位

清醒俯卧位（APP）广泛用于冠状病毒病（COVID-19）患者的管理。本研究的主要目的是比较早期和晚期接受 APP 的 COVID-19 患者的结果。对随机对照试验收集的数据进行事后分析 (ClinicalTrials.gov NCT04325906)。包括因 COVID-19 继发急性低氧性呼吸衰竭且接受 APP 至少一小时的成年患者。早期俯卧位定义为高流量鼻插管 (HFNC) 启动后 24 小时内启动 APP。主要结局是 28 天死亡率和插管率。我们纳入了 125 名患者（79 名男性），平均年龄为 62 岁。其中，92 人（73.6%）提前收到 APP，33 人（26.4%）收到晚 APP。早期 APP 组和晚期 APP 组从 HFNC 开始到 APP 的中位时间分别为 2.25 (0.8–12.82) 和 36.35 (30.2–75.23) 小时 (p < 0.0001)。早期 APP 组和晚期 APP 组的平均 APP 持续时间分别为每天 5.07 (2.0–9.05) 和 3.0 (1.09–5.64) 小时 (p < 0.0001)。早期 APP 组的死亡率低于晚期 APP 组（26% vs 45%，p = 0.039），但插管率没有差异。高龄（OR 1.12 [95% CI 1.0–1.95]，p = 0.001）、插管（OR 10.65 [95% CI 2.77–40.91]，p = 0.001）、启动 APP 的时间较长（OR 1.02 [95% CI 1.0） –1.04]，p = 0.047）和氢化可的松的使用（OR 6.2 [95% CI 1.23–31.1]，p = 0.027）与死亡率增加相关。在 COVID-19 继发的急性低氧性呼吸衰竭中尽早开始（使用 HFNC < 24 小时）APP 可提高 28 天生存率。试验注册 ClinicalTrials.gov NCT04325906。