An international clinical trial carried out in 42 hospitals in six countries , two of them Spanish -Vall d’Hebron and Hospital del Mar- has shown that putting non-intubated patients with severe COVID-19 in the prone position , that is, face down , improves your prognosis and reduces the need for intubation and mortality.
The study, published today in the journal ‘The Lancet Respiratory Medicine’ , is the first major research that analyzes the benefits of this change in position and opens the door to a change in current clinical practice to incorporate this treatment as part of the routine for non-intubated patients with COVID-19.
Before this clinical trial, Dr. Jordi Mancebo, director of the Intensive Medicine Service of the Hospital de Sant Pau in Barcelona and one of the first to apply this technique in Spain, explained last November in an interview with Efe that in his In the hospital, 80% of COVID-19 patients who were in ICUs were already placed in the prone position to improve arterial oxygenation.
This technique is applied in most Spanish ICUs
In fact, in most ICUs of Spanish hospitals this technique is already applied to patients with severe Acute Respiratory Distress Syndrome (ARDS) , due to the benefits that this position entails for the good evolution of the disease.
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Now, this international study, coordinated by the Hospital de Tours (France), has empirically corroborated for the first time something that many intesivists had already proven: that placing the patient face down improves the evolution of patients with severe COVID-19 treated with oxygen therapy high flow.
High-flow oxygen therapy is applied when there is severe acute respiratory failure, in this case, due to COVID-19.
“Scientific evidence of the efficacy of this technique in non-intubated patients is especially important during the peaks of the pandemic when there may be a shortage of ventilators . This is the first major research looking at the benefits of a change in position in awake and awake patients. that they do not need a respirator, that is, they breathe spontaneously on their own, as part of the treatment in COVID-19 patients “, explained the medical coordinator of the ICU of the Vall d’Hebron Hospital, Oriol Roca.
Half of them, the control group, were treated with the usual protocol, and the other half, the experimental group, were positioned in the prone position for at least one hour a day, in a minimum of two sessions of 30 minutes, and with an average of 5 hours a day.
In the control group, 46% of the patients required intubation or had a fatal prognosis up to 28 days after inclusion in the study. This percentage was reduced to 40% among the patients in the experimental group, who had spent time in the prone position.
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The study has also verified that this last group all the breathing indicators improved greatly already during the first session – of 3 hours on average – and the improvement was maintained when returning to the supine position.
According to doctors, avoiding intubation reduces the risk of suffering complications from this cause and also implies a collective benefit by having less need for the use of respirators, one of the equipment with less availability in many countries.
In addition, among those who were in the prone position for at least eight hours a day, only 17% ended in intubation or death , compared to 48% in those who spent less than this time, according to the study in which hospitals in Spain participated. , France, Canada, Mexico, Ireland and the United States.
The trial concludes that the use of this measure is safe and very simple to apply and does not cause any type of cost, without associated risks.
” We therefore propose a change in current clinical practice to incorporate this treatment as part of the medical routine for COVID-19 patients with acute respiratory failure who need high-flow oxygen therapy,” concluded Roca, who is also a researcher at the Shock, Organic Dysfunction and Resuscitation research group (SODIR) of the Vall d’Hebron Research Institute (VHIR).