Patients admitted to the ICU with severe hypoxemia are at high risk for mortality. Few therapies have been proven to improve patient outcomes or duration of mechanical ventilation e.g. low tidal volume ventilation, prone positioning, and a fluid-restrictive strategy. Prone positioning is a technique used to help patients with acute respiratory distress syndrome breathe better. There is high degree of uncertainty on its effects on clinical outcomes in non-intubated patients with acute hypoxemia and larger studies are needed.
we plan to study the effect of prone positioning versus standard treatment in non-intubated patients with acute hypoxemia admitted at Respiratory Intensive Care Unit (RICU), Chest Department, Assiut University Hospital, Egypt.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
244
The target duration of prone positioning is 8 h/d to 10 h/d with 2 to 3 breaks (1-2 hours each), if needed. Daily prone positioning sessions will be protocolized to continue until 1 of the following stopping criteria is met: a relative improvement in the FIO2 requirement by 40% from the baseline value that sustained for 24 hours; endotracheal intubation; or discharge from the ICU.
Number of participants within intervention arm whom need endotracheal intubation.
Intubation is needed when one major criterion including (cardiac or respiratory arrest; hemodynamic instability, life threatening arrhythmias, inability to protect the airway; coma or psychomotor agitation and intolerance to NIV interface; and two of the following minor criteria: RR\> 35/min., PaO2/FiO2\<200 mmHg, and respiratory acidosis (pH\<7.30)).
Time frame: 30 days of randomization.
Number of days on a ventilator.
weaning considered successful if patient is able to achieve the following within 48 hours: pH \>7.35, Decrease in PaCO2 of \>15-20%, PaO2\>60 mmHg, SaO2\> 90% on FiO2 \<40%, Respiratory rate \< 24 bpm and No signs of respiratory distress like agitation, diaphoresis or anxiety.
Time frame: 30 days of randomization.
mortality.
Time frame: 60 days of randomization.
Length of ICU stay in days.
duration of ICU stay from time of admission till discharge from ICU in days.
Time frame: 60 days of randomization.
Length of hospital stay in days.
Time frame: 60 days of randomization.
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