ASSOCIAÇÃO DA CÂNULA NASAL DE ALTO FLUXO E POSIÇÃO PRONA EM PACIENTES ACORDADOS COM INSUFICIÊNCIA RESPIRATÓRIA AGUDA HIPOXÊMICA POR COVID-19: UM ESTUDO DE COORTE RETROSPECTIVO

Introduction: High-flow nasal cannula (HFNC) therapy is an alternative ventilatory support for cases of hypoxaemic acute respiratory failure (ARF) and has been widely used during COVID-19. The prone position improves hypoxaemia as well as the ventilation/perfusion ratio through alveolar recruitment.Objective: To evaluate the effectiveness of the combination of NFC and prone position in the treatment of awake patients with hypoxaemic ARF due to COVID- 19.Methods: Retrospective cohort study, carried out from August 2020 to August 2021. Patients over the age of 18 with ARF due to COVID-19 who used NAC associated or not with awake prone positioning were included. The main outcomes analysed were the need for invasive mechanical ventilation (MV) and hospital mortality.Results: Of the 1,125 patients admitted to the adult ICU, 300 used NFC. Of these, 182 patients performed the prone position and 118 did not tolerate the position. Patients who tolerated the awake prone position had a lower need for MV (29.1% vs 52.5%, p<0.001) and lower mortality (15.9% vs 29.7%, p=0.005) compared to the group that did not tolerate the prone position. Patients aged ≥70 years had a higher chance of MV (HR 3.36 [1.35-8.34], p=0.009) and the ROX index 6 h was an independent predictor of mortality.Survival in the group that tolerated prone was 23 days.Conclusion: In awake patients with hypoxaemic ARF due to COVID, tolerance to the prone position reduces the need for intubation and hospital mortality.