Background: During the COVID-19 pandemic the application of awake prone position (PP) in subjects has been describing such as a new procedures in combating the acute hypoxemic. Aim: Evaluate the efficacy of the awake PP in patients with hypoxemic respiratory failure by COVID-19 to avoid mechanical ventilation (MV). Methods: a clinical study. The subjects who were showing signs of hypoxemic respiratory failure were divided into two groups: the intervention group receiving treatment with oxygen therapy plus awake PP, and the control group only oxygen therapy. The primary outcome was the success to avoid the MV, and secondary outcomes were complications, length of stay and mortality rate in the ICU. Results: Thirty-two subjects underwent the PP in the Intervention group, and 35 maintained the conventional treatment with the oxygen therapy in the control group. The mean of the clinical variables analyzed did not show difference when comparing the groups. The rate of need of invasive mechanical ventilation (60% vs. 41%, P=0.18) and death rate (29% vs. 13%, P=0.29) was higher in the control group; however statistical diferences not were found. In the Kaplan-Meyer curves, the awake PP presented a tendency of reduction in mortality rate (15%), P=0.29 and presented a tendency of increase (30%) successful to avoid MV, P=0.16. Conclusion:The present study despite demonstrating that a simple procedure seems to contribute with a success rate to avoid the mechanical ventilator, however we cannot affirm this result. Lastly, we suggest that news RCT studies be carried out to confirm this find.

BackgroundIn a previous study we showed that troponin I (TnI) > 0.42 ng/mL predicted the need of dialysis in a group of 29 septic patients admitted to the intensive care unit (ICU). We aimed to confirm such finding in a larger independent sample.MethodsAll septic patients admitted to an ICU from March 2016 to February 2017 were included if age between 18 and 90 years, onset of sepsis < 24 h, normal left ventricular ejection fraction, and no previous coronary or kidney diseases. TnI was measured on day 1. Patients were followed by 30 days or until death.ResultsA total of 120 patients were included (51% male, 74 ± 13 years old). At ICU admission, 70 patients had TnI > 0.42 ng/mL. These patients had serum creatinine slightly higher (1.66 ± 0.34 vs. 1.32 ± 0.39 mg/dL; P <  0.0001) than those with lower TnI and similar urine output (1490 ± 682 vs. 1406 ± 631 mL; P = 0.44). At the end of the follow-up period, 70.0% of the patients with lower TnI were alive in comparison with 38.6% of those with higher TnI (p = 0.0014). After 30 days, 69.3 and 2.9% of the patients with lower and higher TnI levels remained free of dialysis, respectively (p <  0.0001). In a Cox regression model, after adjustment for gender, age, Charlson comorbidity index, serum creatinine, potassium, pH, brain natriuretic peptide and urine output, TnI > 0.42 ng/mL persisted as a strong predictor of dialysis need (hazard ratio 3.48 [95%CI 1.69–7.18]).ConclusionsTnI levels at ICU admission are a strong independent predictor of dialysis need in sepsis.