A predictive model for early intubation in patients with COVID-19-induced acute hypoxemic respiratory failure under awake prone position
Morales-Quinteros, Luis (Vall d'Hebron Institut de Recerca (VHIR))
Fuentes, Nora Angélica (Universidad Nacional de Mar del Plata)
Muriel, Alfonso (Hospital Universitario Ramón y Cajal (Madrid))
Olmos, Matías (Universidad Nacional de Mar del Plata)
Busico, Marina (Clínica Olivos SMG)
Vitali, Alejandra (Sanatorio de la Trinidad Palermo)
Gallardo, Adrián (Universidad de Morón)
Plata-Menchaca, Erika P. (Hospital Universitari Vall d'Hebron)
Ferrer, Ricard (Universitat Autònoma de Barcelona. Departament de Medicina)
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Esperatti, Mariano (Universidad Nacional de Mar del Plata)

Date:	2025
Abstract:	Awake prone positioning (APP) reduces the risk of endotracheal intubation and mortality in COVID-19-related acute respiratory failure (ARF) receiving high-flow nasal oxygen (HFNO). However, a significant proportion of patients undergoing APP are ultimately intubated, and mortality in this subgroup remains high. We aimed to develop a predictive model to be applied within the first 24 h of APP to identify patients at higher risk of progressing to intubation within 72 h of APP initiation. We conducted a secondary analysis of a prospective multicenter cohort including adult patients with COVID-19-related ARF admitted to six intensive care units in Argentina between June 2020 and January 2021. Eligible patients received HFNO and APP for at least 6 h per day. Physiological variables were collected at ICU admission (baseline) and 24 h after APP initiation. Two multivariable logistic regression models were developed using baseline and 24-hour variables, respectively. Predictors were selected based on clinical relevance and univariable associations. A final model was constructed by integrating variables retained from both time points. Of 400 patients included, 136 (34%) required intubation within the first 72 h. Patients who required intubation were older, had lower PaO₂ and PaO₂/FiO₂ ratios, and higher respiratory rates both at baseline and after 24 h. The final predictive model included five variables: age, respiratory rate, PaO₂, FiO₂, and SaO₂/FiO₂ ratio, all measured 24 h after APP initiation. A nomogram was developed based on this model to estimate the individual risk of early intubation. In patients with COVID-19-related ARF treated with HFNO and APP, a model combining baseline characteristics and early physiological response can help predict the need for intubation within 72 h. This tool may support clinicians in identifying high-risk patients and making timely, individualized decisions about escalation of care.
Grants:	European Society of Intensive Care Medicine European Society of Intensive Care Medicine
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Prone positioning ; Acute respiratory failure ; High flow nasal cannula ; COVID-19 ; Acute respiratory distress syndrome
Published in:	Annals of Intensive Care, Vol. 15, Num. 1 (November 2025) , art. 188, ISSN 2110-5820

DOI: 10.1186/s13613-025-01602-4
PMID: 41284115

9 p, 1.5 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Articles > Research articles
Articles > Published articles