• Jessica Downing, Stephanie Cardona, Reem Alfalasi, Shahrad Shadman, Amina Dhahri, Riddhi Paudel, Portia Buchongo, Bradford Schwartz, and Quincy K Tran.
• Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: jvdowning@som.umaryland.edu.
• Am J Emerg Med. 2021 Nov 1; 49: 276286276-286.

BackgroundAwake prone positioning (PP) has been used to avoid intubations in hypoxic COVID-19 patients, but there is limited evidence regarding its efficacy. Moreover, clinicians have little information to identify patients at high risk of intubation despite awake PP. We sought to assess the intubation rate among patients treated with awake PP in our Emergency Department (ED) and identify predictors of need for intubation.MethodsWe conducted a multicenter retrospective cohort study of adult patients admitted for known or suspected COVID-19 who were treated with awake PP in the ED. We excluded patients intubated in the ED. Our primary outcome was prevalence of intubation during initial hospitalization. Other outcomes were intubation within 48 h of admission and mortality. We performed classification and regression tree analysis to identify the variables most likely to predict the need for intubation.ResultsWe included 97 patients; 44% required intubation and 21% were intubated within 48 h of admission. Respiratory oxygenation (ROX) index and P/F (partial pressure of oxygen / fraction of inspired oxygen) ratio measured 24 h after admission were the variables most likely to predict need for intubation (area under the receiver operating characteristic curve = 0.82).ConclusionsAmong COVID-19 patients treated with awake PP in the ED prior to admission, ROX index and P/F ratio, particularly 24 h after admission, may be useful tools in identifying patients at high risk of intubation.Copyright © 2021 Elsevier Inc. All rights reserved.

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