Trial suggests awake prone position doesn't cut need for intubation in COVID
A randomized, controlled trial of 400 adults hospitalized for COVID-19–related respiratory failure suggests that awake prone positioning doesn't significantly reduce the need for endotracheal intubation at 30 days, but the authors caution that the effect size was imprecise and a therapeutic benefit cannot be ruled out.
Published yesterday in JAMA, the study was led by McMaster University researchers and enrolled nonintubated respiratory failure patients who needed supplemental oxygen at 21 hospitals in Canada, Kuwait, Saudi Arabia, and the United States from May 19, 2020, to May 18, 2021. Patients were, on average, 57.6 years old, 29.3% were women, 205 were assigned to receive prone positioning, and 195 served as controls.
In the first 4 days, intervention patients were placed in the prone position for 4.8 hours per day. By 30 days, 70 of 205 (34.1%) intervention patients advanced to needing endotracheal intubation, compared with 79 of 195 (40.5%) of controls. The hazard ratio [HR] was 0.81, but the result was not statistically significant.
By 60 days, prone positioning hadn't significantly reduced the death rate (HR, 0.93; absolute difference, −1.15%) or increased days free from invasive or noninvasive mechanical ventilation or intensive care unit stay, or shortened hospital stay.
In the intervention group, 21 patients (10%) had adverse events, the most common of which was musculoskeletal pain from prone positioning (13 [6.34%]) and oxygen desaturation (2 [0.98%]). No serious adverse events were reported.
The researchers noted that prone positioning has been used to treat patients undergoing invasive mechanical ventilation for acute respiratory distress syndrome (ARDS) since the 1970s. Previous trials have produced mixed results in COVID-19 patients, and the most current practice guideline on treating sepsis in COVID-19 said that evidence to support a recommendation on it is lacking.
Awake prone positioning may not benefit patients with more severe infections, the authors said. "However, the false discovery rate did not reach statistical significance for any of the preplanned subgroups; therefore, these findings should be interpreted with great caution and considered hypothesis generating," they wrote.
May 15 JAMA study
Avian flu outbreaks strike more poultry in 4 states
Four states reported more highly pathogenic avian flu outbreaks, with two of the events involving commercial farms in Pennsylvania and Wisconsin, according to the latest updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).
In Pennsylvania, the virus struck a layer poultry breeding farm in Berks County in the southeast housing 83,700 birds. So far, all 10 of the state's avian flu outbreaks have occurred at commercial farms, 6 of them at layer facilities. Pennsylvania is the nation's fourth-largest table egg producer.
Meanwhile, Wisconsin reported an outbreak at a commercial turkey farm housing 10,500 birds in Barron County in the northwest.
Two western states—Idaho and Wyoming—reported more outbreaks in backyard birds. Idaho reported two, one in Ada County and the other in neighboring Canyon County, both in the southwestern part of the state. Wyoming also reported a pair of outbreaks, one in Lincoln County in the southwest and the other in Sheridan County in the north central part of the state.
The latest outbreaks are part of ongoing Eurasian H5N1 activity affecting US poultry flocks and wild birds. The virus has affected poultry flocks in 34 states and has so far led to the loss of 37.72 million birds.
USDA APHIS avian flu update
Two new monkeypox cases identified in UK
Two new monkeypox cases have been identified in London residents, according to the UK Health Security Agency (UKHSA).
The case-patients live together in a household and have no connection to a monkeypox case reported earlier this month by the UKHSA. One person is currently hospitalized for the virus, while the other is isolated and recovering at home.
"While investigations remain ongoing to determine the source of infection, it is important to emphasise it does not spread easily between people and requires close personal contact with an infected symptomatic person. The overall risk to the general public remains very low," said Colin Brown, MBChB, the director of clinical and emerging infections at UKHSA.
Most cases of monkeypox are mild, but the virus can be severe and even deadly. UK health authorities emphasize that the virus is not highly contagious.
Earlier this month UK authorities confirmed monkeypox in a person who had recently traveled to Nigeria. According to a World Health Organization (WHO) update today, contact tracing has revealed no additional cases.
The WHO said, "Based on the travel history and rash illness, monkeypox was suspected at an early stage and the case was isolated immediately. Appropriate use of personal protective equipment was ensured during hospitalization."
May 14 UKHSA press statement
May 16 WHO update on previous case