Accepted for Publication: February 26, 2022.
Published Online: April 18, 2022. doi:10.1001/jamainternmed.2022.1070
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Qian ET et al. JAMA Internal Medicine.
Corresponding Author: Edward Tang Qian, MD, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, T-1218 MCN, 1161 21st Ave S, Nashville, TN 37232-2650 (email@example.com).
Author Contributions: Drs Qian and Lindsell had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Qian and Gatto contributed equally as first authors. Drs Lindsell and Rice contributed equally as senior authors.
Concept and design: Qian, Gatto, Dear, Hiser, Buie, Kripalani, Harrell, Freundlich, Burke, Billings, Pulley, Bernard, Lindsell, Rice.
Acquisition, analysis, or interpretation of data: Qian, Amusina, Dear, Hiser, Buie, Kripalani, Harrell, Freundlich, Gao, Gong, Hennessy, Grooms, Mattingly, Bellam, Zakaria, Vasilevskis, Billings, Pulley, Lindsell, Rice.
Drafting of the manuscript: Qian, Gatto, Dear, Hiser, Buie, Zakaria, Billings, Pulley, Rice.
Critical revision of the manuscript for important intellectual content: Gatto, Amusina, Dear, Hiser, Buie, Kripalani, Harrell, Freundlich, Gao, Gong, Hennessy, Grooms, Mattingly, Bellam, Burke, Vasilevskis, Billings, Pulley, Bernard, Lindsell, Rice.
Statistical analysis: Harrell, Gao, Gong, Hennessy, Lindsell.
Obtained funding: Bernard.
Administrative, technical, or material support: Qian, Gatto, Amusina, Dear, Hiser, Buie, Freundlich, Grooms, Mattingly, Zakaria, Vasilevskis, Pulley, Bernard, Rice.
Supervision: Gatto, Dear, Hiser, Kripalani, Freundlich, Vasilevskis, Pulley, Bernard, Rice.
Other–principal investigator at one of the sites: Amusina.
Conflict of Interest Disclosures: Dr Qian reported receiving grants from the National Heart, Lung, and Blood Institute during the conduct of the study. Dr Gatto reported receiving grants from the National Center for Advancing Translational Sciences (NCATS) during the conduct of the study. Dr Dear reported receiving grants from the NCATS during the conduct of the study. Mr Hiser reported receiving grants from the NCATS during the conduct of the study. Dr Bernard reported receiving grants from the NCATS during the conduct of the study. Dr Lindsell reported receiving grants from the NCATS during the conduct of the study; grants from the Centers for Disease Control and Prevention, the National Institutes of Health, and the US Department of Defense; fees for research services from AbbVie, bioMérieux, Endpoint Health, and Entegrion; and owning a patent for risk stratification in sepsis and septic shock (licensed to Cincinnati Children’s Hospital Medical Center) outside the submitted work. Dr Rice reported receiving grants from the NCATS during the conduct of the study and personal fees from Cumberland Pharmaceuticals, Cytovale, and Sanofi outside the submitted work. No other disclosures were reported.
Funding/Support: The work was supported by grant UL1 TR002243 from the National Center for Advancing Translational Sciences (Drs Gatto and Dear, Mr Hiser, and Drs Bernard, Lindsell, and Rice); grant T32HL087738 from the National Heart, Lung, and Blood Institute (Dr Qian); grant K23HL148640 from the National Heart, Lung, and Blood Institute (Dr Freundlich); grant R01GM112871 from the National Institute of General Medical Sciences (Dr Billings); and grants to the institution from the Dolly Parton COVID-19 Research Fund (Drs Gatto and Dear, Mr Hiser, and Dr Rice).
Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Group Information: A complete list of the members of the Vanderbilt Learning Healthcare System Platform Investigators appears in Supplement 3.
Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.
Data Sharing Statement: See Supplement 4.
Additional Contributions: The authors are indebted to the patients and the frontline staff who endured the COVID-19 pandemic. Zameer Lodhi, BBA, MS, of Vanderbilt University provided assistance with data acquisition, and Elizabeth A. Rice, MD, SFHM, of Vanderbilt University provided coordination with clinical teams. We thank the COVID-19 charge nurses and the 8 nurse leaders and educators from Vanderbilt Medical Center East and the members of the Vanderbilt Coordinating Center, including Jill Janssen, RN, BSN; Jessica B. Collins, BA; Jenna Caserta, RN, BSN; Alesia Pruitt, BS; Jessica S. Marlin, CCRP; Krista K. Vermillion, MS, MPM; and David S. McKeel, BS. Osasumwen Osayimwen, MD, MPH, of the NorthShore University HealthSystem provided frontline care. We also acknowledge the contributions of the NorthShore University HealthSystem COVID-19 hospitalist team; the nursing staff of the NorthShore University HealthSystem; and the nursing administration at Glenbrook Hospital. The sensor work of Drs Qian, Gatto, Lindsell, and Rice was supported by Smith & Nephew, with guidance provided by Annemari Cooley, MBA, MA; Mike Pihulic, Meng; Angela Lin, MS; and Alvin Cheung, BS (all of whom were employed by Smith & Nephew). None of the contributors received additional compensation for their work.
G , Zangrillo
A , Zanella
et al; COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA
. 2020;323(16):1574-1581. doi:10.1001/jama.2020.5394
JH , Tomashek
KM , Dodd
LE . Remdesivir for the treatment of COVID-19—preliminary report. reply. N Engl J Med
. 2020;383(10):994. Published online May 22, 2020. PubMedGoogle Scholar
AB , Zampieri
FG , Rosa
et al; Coalition COVID-19 Brazil I Investigators. Hydroxychloroquine with or without azithromycin in mild-to-moderate COVID-19. N Engl J Med
. 2020;383(21):2041-2052. doi:10.1056/NEJMoa2019014
JM , Bae
W , Lee
YJ , Cho
YJ . The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med
. 2014;42(5):1252-1262. doi:10.1097/CCM.0000000000000122
V , Grasselli
G , Castagna
et al. Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: a retrospective study. J Crit Care
. 2015;30(6):1390-1394. doi:10.1016/j.jcrc.2015.07.008
P , Esmaeili
M . Prone position in management of COVID-19 patients; a commentary. Arch Acad Emerg Med
. 2020;8(1):e48.PubMedGoogle Scholar
A , Bellani
G , Winterton
et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Respir Med
. 2020;8(8):765-774. doi:10.1016/S2213-2600(20)30268-X
C , Mellado-Artigas
R , Gea
et al; COVID-19 Spanish ICU Network. Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study. Crit Care
. 2020;24(1):597. doi:10.1186/s13054-020-03314-6
PA , Taylor
R , Thielke
R , Payne
J , Gonzalez
N , Conde
JG . Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform
. 2009;42(2):377-381. doi:10.1016/j.jbi.2008.08.010
Y , Vehtari
A , Simpson
D , Gelman
A . Using stacking to average bayesian predictive distributions (with discussion). Bayesian Anal
. 2018;13(3):917-1007. doi:10.1214/17-BA1091Google ScholarCrossref
S , Li
J , Ibarra-Estrada
et al; Awake Prone Positioning Meta-Trial Group. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med
. 2021;9(12):1387-1395. doi:10.1016/S2213-2600(21)00356-8
SP , Bundy
H , Smith
WM , Skavroneck
S , Taylor
B , Kowalkowski
MA . Awake prone positioning strategy for nonintubated hypoxic patients with COVID-19: a pilot trial with embedded implementation evaluation. Ann Am Thorac Soc
. 2021;18(8):1360-1368. doi:10.1513/AnnalsATS.202009-1164OC