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10.1016/S2213-2600(20)30268-X http://scihub22266oqcxt.onion/10.1016/S2213-2600(20)30268-X 32569585!7304954!32569585     free     free     free Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 265.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 265.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 265.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 265.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 265.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 265.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 265.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 298.79999999999995 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 298.79999999999995 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 298.79999999999995 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534       Lancet+Respir+Med 2020 ; 8 (8): 765-774 Nephropedia Template TP {{tp|p=32569585|t=2020. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study |pdf=|usr=}}{{32569585}} gab.com Text Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study JO: Lancet Respir Med http://www.kidney.de/pget.php?&tw=1&pmid=32569585 #FOAvip BACKGROUND: The COVID-19 pandemic is challenging advanced health systems, which are dealing with an overwhelming number of patients in need of intensive care for respiratory failure, often requiring intubation. Prone positioning in intubated patients is known to reduce mortality in moderate-to-severe acute respiratory distress syndrome. We aimed to investigate feasibility and effect on gas exchange of prone positioning in awake, non-intubated patients with COVID-19-related pneumonia. METHODS: In this prospective, feasibility, cohort study, patients aged 18-75 years with a confirmed diagnosis of COVID-19-related pneumonia receiving supplemental oxygen or non-invasive continuous positive airway pressure were recruited from San Gerardo Hospital, Monza, Italy. We collected baseline data on demographics, anthropometrics, arterial blood gas, and ventilation parameters. After baseline data collection, patients were helped into the prone position, which was maintained for a minimum duration of 3 h. Clinical data were re-collected 10 min after prone positioning and 1 h after returning to the supine position. The main study outcome was the variation in oxygenation (partial pressure of oxygen [PaO(2)]/fractional concentration of oxygen in inspired air [FiO(2)]) between baseline and resupination, as an index of pulmonary recruitment. This study is registered on ClinicalTrials.gov, NCT04365959, and is now complete. FINDINGS: Between March 20 and April 9, 2020, we enrolled 56 patients, of whom 44 (79%) were male; the mean age was 57.4 years (SD 7.4) and the mean BMI was 27.5 kg/m(2) (3.7). Prone positioning was feasible (ie, maintained for at least 3 h) in 47 patients (83.9% [95% CI 71.7 to 92.4]). Oxygenation substantially improved from supine to prone positioning (PaO(2)/FiO(2) ratio 180.5 mm Hg [SD 76.6] in supine position vs 285.5 mm Hg [112.9] in prone position; p<0.0001). After resupination, improved oxygenation was maintained in 23 patients (50.0% [95% CI 34.9-65.1]; ie, responders); however, this improvement was on average not significant compared with before prone positioning (PaO(2)/FiO(2) ratio 192.9 mm Hg [100.9] 1 h after resupination; p=0.29). Patients who maintained increased oxygenation had increased levels of inflammatory markers (C-reactive protein: 12.7 mg/L [SD 6.9] in responders vs 8.4 mg/L [6.2] in non-responders; and platelets: 241.1 x 10(3)/muL [101.9] vs 319.8 x 10(3)/muL [120.6]) and shorter time between admission to hospital and prone positioning (2.7 days [SD 2.1] in responders vs 4.6 days [3.7] in non-responders) than did those for whom improved oxygenation was not maintained. 13 (28%) of 46 patients were eventually intubated, seven (30%) of 23 responders and six (26%) of 23 non-responders (p=0.74). Five patients died during follow-up due to underlying disease, unrelated to study procedure. INTERPRETATION: Prone positioning was feasible and effective in rapidly ameliorating blood oxygenation in awake patients with COVID-19-related pneumonia requiring oxygen supplementation. The effect was maintained after resupination in half of the patients. Further studies are warranted to ascertain the potential benefit of this technique in improving final respiratory and global outcomes. FUNDING: University of Milan-Bicocca. Twit Text FOAVip Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study ????Lancet Respir Med http://www.kidney.de/pget.php?&tw=1&pmid=32569585 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=32569585 #FOAvip English Wikipedia <ref>{{Cite pmid|32569585}}</ref> Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study #MMPMID32569585 Coppo A; Bellani G; Winterton D; Di Pierro M; Soria A; Faverio P; Cairo M; Mori S; Messinesi G; Contro E; Bonfanti P; Benini A; Valsecchi MG; Antolini L; Foti G Lancet Respir Med 2020[Aug]; 8 (8): 765-774 PMID32569585show ga BACKGROUND: The COVID-19 pandemic is challenging advanced health systems, which are dealing with an overwhelming number of patients in need of intensive care for respiratory failure, often requiring intubation. Prone positioning in intubated patients is known to reduce mortality in moderate-to-severe acute respiratory distress syndrome. We aimed to investigate feasibility and effect on gas exchange of prone positioning in awake, non-intubated patients with COVID-19-related pneumonia. METHODS: In this prospective, feasibility, cohort study, patients aged 18-75 years with a confirmed diagnosis of COVID-19-related pneumonia receiving supplemental oxygen or non-invasive continuous positive airway pressure were recruited from San Gerardo Hospital, Monza, Italy. We collected baseline data on demographics, anthropometrics, arterial blood gas, and ventilation parameters. After baseline data collection, patients were helped into the prone position, which was maintained for a minimum duration of 3 h. Clinical data were re-collected 10 min after prone positioning and 1 h after returning to the supine position. The main study outcome was the variation in oxygenation (partial pressure of oxygen [PaO(2)]/fractional concentration of oxygen in inspired air [FiO(2)]) between baseline and resupination, as an index of pulmonary recruitment. This study is registered on ClinicalTrials.gov, NCT04365959, and is now complete. FINDINGS: Between March 20 and April 9, 2020, we enrolled 56 patients, of whom 44 (79%) were male; the mean age was 57.4 years (SD 7.4) and the mean BMI was 27.5 kg/m(2) (3.7). Prone positioning was feasible (ie, maintained for at least 3 h) in 47 patients (83.9% [95% CI 71.7 to 92.4]). Oxygenation substantially improved from supine to prone positioning (PaO(2)/FiO(2) ratio 180.5 mm Hg [SD 76.6] in supine position vs 285.5 mm Hg [112.9] in prone position; p<0.0001). After resupination, improved oxygenation was maintained in 23 patients (50.0% [95% CI 34.9-65.1]; ie, responders); however, this improvement was on average not significant compared with before prone positioning (PaO(2)/FiO(2) ratio 192.9 mm Hg [100.9] 1 h after resupination; p=0.29). Patients who maintained increased oxygenation had increased levels of inflammatory markers (C-reactive protein: 12.7 mg/L [SD 6.9] in responders vs 8.4 mg/L [6.2] in non-responders; and platelets: 241.1 x 10(3)/muL [101.9] vs 319.8 x 10(3)/muL [120.6]) and shorter time between admission to hospital and prone positioning (2.7 days [SD 2.1] in responders vs 4.6 days [3.7] in non-responders) than did those for whom improved oxygenation was not maintained. 13 (28%) of 46 patients were eventually intubated, seven (30%) of 23 responders and six (26%) of 23 non-responders (p=0.74). Five patients died during follow-up due to underlying disease, unrelated to study procedure. INTERPRETATION: Prone positioning was feasible and effective in rapidly ameliorating blood oxygenation in awake patients with COVID-19-related pneumonia requiring oxygen supplementation. The effect was maintained after resupination in half of the patients. Further studies are warranted to ascertain the potential benefit of this technique in improving final respiratory and global outcomes. FUNDING: University of Milan-Bicocca. |*Betacoronavirus[MESH] |*Prone Position[MESH] |Adolescent[MESH] |Adult[MESH] |Aged[MESH] |COVID-19[MESH] |Coronavirus Infections/*physiopathology/therapy[MESH] |Critical Care/methods[MESH] |Feasibility Studies[MESH] |Female[MESH] |Humans[MESH] |Male[MESH] |Middle Aged[MESH] |Pandemics[MESH] |Pneumonia, Viral/*physiopathology/therapy[MESH] |Prospective Studies[MESH] |Pulmonary Gas Exchange/*physiology[MESH] |Respiratory Distress Syndrome/*physiopathology/therapy/virology[MESH] |Respiratory Mechanics/physiology[MESH] |SARS-CoV-2[MESH]Feasibility and physiological effects of prone positioning in non-intu(epmc).pdf DeepDyve Pubget Overpricing