Introduction This study aimed to describe the use of awake prone positioning (APP) and conventional oxygen therapy (COT) in patients with suspected coronavirus disease (COVID-19) and respiratory failure in a limited-resource setting. Methods This was a retrospective cohort study of hospitalized patients aged ≥18 years old who were placed in an awake prone position due to hypoxemic respiratory failure and suspected COVID-19. The patients were selected from a tertiary center in Cartagena, Colombia, between March 1, 2020, and August 31, 2020. Demographic, clinical, and laboratory variables were collated, and all the variables were compared between the groups. Results The median age of the participants was 63 (IQR, 48.8-73) years (survivors: 59 [IQR, 43.568] years vs. non-survivors: 70 [IQR, 63-78] years, P ≤ .001). Of the 1470 patients admitted for respiratory symptoms, 732 (49.8%) were hospitalized for more than 24 h, and 212 patients developed respiratory failure and required COT and APP (overall hospital mortality, 34% [73/212]). The mean rank difference in PaO2/FiO2 before and after APP was higher in the survivors than in the non-survivors (201.1-252.6, mean rank difference = 51.5, P = .001 vs. 134.1-172.4, mean rank difference = 38.28, P = .24, respectively). Conclusion While using COT in conjunction with APP can improve respiratory failure in patients with suspected COVID-19 in low-resource settings, persistent hypoxemia after APP can identify patients with higher mortality risk. More evidence is needed to establish the role of this strategy.

No abstract

Con la pandemia se implementaron diversas estrategias para evitar la intubación y la ventilación mecánica invasiva. La posición prona (PP) tiene claros efectos benéficos en mejorar oxigenación por diversos mecanismos al tiempo que genera cambios hemodinámicos que pueden optimizar la función del ventrículo derecho. La evidencia de la PP en pacientes con síndrome de dificultad respiratoria aguda (SDRA) en ventilación mecánica invasiva (VMI) es contundente y obliga a considerarla en las primeras 24 horas de pacientes con PaO2/FiO2<150. La posición prona en respiración espontánea (PPRE) puede mejorar la oxigenación en pacientes con falla respiratoria e implementada mediante un protocolo que incluye una adecuada selección de pacientes puede evitar la intubación de pacientes en falla respiratoria. La presente revisión resume los antecedentes históricos, las bases fisiológicas de la posición prono en el paciente despierto, así como la evidencia que evalúa su aplicación en el paciente con COVID-19 al tiempo que resume el protocolo y la experiencia de un centro con esta estrategia como propuesta para estudios multicéntricos.

No abstract

Background COVID-19 infection is characterized by its heterogeneity in clinical presentation. Hospital admission, intensive care unit (ICU) admission and mortality rates have shown wide variations throughout the months. Colombia experienced a high rate of COVID-19 infection, leading to significant morbidity and mortality. To date, there are only a few studies reporting peak variations. Therefore, we aimed to explore the potential reasons for epidemiological changes in COVID-19 with time. Methods This study was conducted at a tertiary referral center in Cartagena, Colombia, between March 7, 2020, and February 28, 2021. We included patients aged > 18 years with suspected or confirmed COVID-19. A diagnosis was made using the reverse-transcriptase polymerase chain reaction (RT-PCR) test. We extracted information from the Colombian National Surveillance System (SIVIGILA). We collected demographic data, such as age, sex, RT-PCR test results, and information on close contacts (awareness of the disease). We categorized the study period into two according to the two peaks defined in Colombia: the first period included weeks 10–35 (March 7–August 30, 2020), and the second period included weeks 36–60 (September 1, 2020-February 28, 2021). We adjusted the weekly overall mortality by covariates to identify potential changes during the pandemic. Results In total, 2761 COVID-19 patients were hospitalized at our institution. The most significant number of cases occurred in the first and second periods during week 21 (peak1: 121 patients) and week 50 (peak2: 128 patients), respectively.