{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T03:22:08Z","timestamp":1784604128117,"version":"3.55.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T00:00:00Z","timestamp":1656288000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T00:00:00Z","timestamp":1656288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Rice Foundation"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Awake prone positioning (APP) reduces the intubation rate in COVID-19 patients treated by high-flow nasal cannula (HFNC). However, the lung aeration response to APP has not been addressed. We aimed to explore the lung aeration response to APP by lung ultrasound (LUS).\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This two-center, prospective, observational study enrolled patients with COVID-19-induced acute hypoxemic respiratory failure treated by HFNC and APP. LUS score was recorded 5\u201310\u00a0min\u00a0before, 1\u00a0h after APP, and 5\u201310\u00a0min after\u00a0supine in the first APP session within the first three days. The primary outcome was LUS score changes in the first three days. Secondary outcomes included changes in SpO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> ratio, respiratory rate and ROX index (SpO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub>\/respiratory rate) related to APP, and the rate of treatment success (patients who avoided intubation).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Seventy-one patients were enrolled. LUS score decreased from 20 (interquartile range [IQR] 19\u201324) to 19 (18\u201321) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) after the first APP session, and to 19 (18\u201321) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) after three days. Compared to patients with treatment failure (<jats:italic>n<\/jats:italic>\u2009=\u200920, 28%), LUS score reduction after the first three days in patients with treatment success (<jats:italic>n<\/jats:italic>\u2009=\u200951) was greater (\u2212\u20092.6 [95% confidence intervals\u2009\u2212\u20093.1 to\u2009\u2212\u20092.0] vs 0 [\u2212\u20091.2 to 1.2], <jats:italic>p<\/jats:italic>\u2009=\u20090.001). A decrease in dorsal LUS score\u2009&gt;\u20091 after the first APP session was associated with decreased risk for intubation (Relative risk 0.25 [0.09\u20130.69]). APP daily duration was correlated with LUS score reduction in patients with treatment success, especially in dorsal lung zones (<jats:italic>r<\/jats:italic>\u2009=\u2009\u2009\u2212\u20090.76; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In patients with acute hypoxemic respiratory failure due to COVID-19 and treated by HFNC, APP reduced LUS score. The reduction in dorsal LUS scores after APP was associated with treatment success. The longer duration on APP was correlated with greater lung aeration.<\/jats:p>\n                <jats:p><jats:italic>Trial registration<\/jats:italic> This study was prospectively registered on clinicaltrials.gov on April 22, 2021. Identification number <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04855162\">NCT04855162<\/jats:ext-link>.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13054-022-04064-3","type":"journal-article","created":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T11:03:03Z","timestamp":1656327783000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Lung ultrasound response to awake prone positioning predicts the need for intubation in patients with COVID-19 induced acute hypoxemic respiratory failure: an observational study"],"prefix":"10.1186","volume":"26","author":[{"given":"Miguel","family":"Ibarra-Estrada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda J.","family":"Gamero-Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Garc\u00eda-de-Acilu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriol","family":"Roca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Sandoval-Plascencia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guadalupe","family":"Aguirre-Avalos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Garc\u00eda-Salcido","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara A.","family":"Aguirre-D\u00edaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L.","family":"Vines","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Mirza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramandeep","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claude","family":"Guerin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,6,27]]},"reference":[{"issue":"23","key":"4064_CR1","doi-asserted-by":"publisher","first-page":"2159","DOI":"10.1056\/NEJMoa1214103","volume":"368","author":"C Gu\u00e9rin","year":"2013","unstructured":"Gu\u00e9rin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. 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Written consent was waived by ethic committees at both hospitals.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"JL discloses research funding from Fisher & Paykel Healthcare Ltd, Aerogen Ltd, and Rice Foundation, and speaker fees from AARC, Aerogen Ltd, Heyer Ltd, and Fisher & Paykel Healthcare Ltd. OR discloses a research grant from Hamilton Medical and speaker fees from Hamilton Medical, Ambu, Fisher & Paykel Ltd and Aerogen Ltd, and non-financial research support from Timpel and Masimo Corporation. DLV discloses research funding from Teleflex Medical, Inc. and Rice Foundation, and speaker fees from Theravance Biopharma. RK discloses research funding from the American Association of Respiratory Care. All other authors have no conflict of interest to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"189"}}