| Title: |
Early prone positioning in acute respiratory distress syndrome related to COVID-19: a propensity score analysis from the multicentric cohort COVID-ICU network—the ProneCOVID study |
| Authors: |
Christophe Le Terrier, Florian Sigaud, Said Lebbah, Luc Desmedt, David Hajage, Claude Guérin, Jérôme Pugin, Steve Primmaz, Nicolas Terzi, COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators |
| Source: |
Critical Care, Vol 26, Iss 1, Pp 1-14 (2022) |
| Publisher Information: |
BMC, 2022. |
| Publication Year: |
2022 |
| Collection: |
LCC:Medical emergencies. Critical care. Intensive care. First aid |
| Subject Terms: |
Acute respiratory distress syndrome, Intubation, COVID-19, Mortality, Prone position, Intensive care unit, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9 |
| More Details: |
Abstract Background Delaying time to prone positioning (PP) may be associated with higher mortality in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). We evaluated the use and the impact of early PP on clinical outcomes in intubated patients hospitalized in intensive care units (ICUs) for COVID-19. Methods All intubated patients with ARDS due to COVID-19 were involved in a secondary analysis from a prospective multicenter cohort study of COVID-ICU network including 149 ICUs across France, Belgium and Switzerland. Patients were followed-up until Day-90. The primary outcome was survival at Day-60. Analysis used a Cox proportional hazard model including a propensity score. Results Among 2137 intubated patients, 1504 (70.4%) were placed in PP during their ICU stay and 491 (23%) during the first 24 h following ICU admission. One hundred and eighty-one patients (36.9%) of the early PP group had a PaO2/FiO2 ratio > 150 mmHg when prone positioning was initiated. Among non-early PP group patients, 1013 (47.4%) patients had finally been placed in PP within a median delay of 3 days after ICU admission. Day-60 mortality in non-early PP group was 34.2% versus 39.3% in the early PP group (p = 0.038). Day-28 and Day-90 mortality as well as the need for adjunctive therapies was more important in patients with early PP. After propensity score adjustment, no significant difference in survival at Day-60 was found between the two study groups (HR 1.34 [0.96–1.68], p = 0.09 and HR 1.19 [0.998–1.412], p = 0.053 in complete case analysis or in multiple imputation analysis, respectively). Conclusions In a large multicentric international cohort of intubated ICU patients with ARDS due to COVID-19, PP has been used frequently as a main treatment. In this study, our data failed to show a survival benefit associated with early PP started within 24 h after ICU admission compared to PP after day-1 for all COVID-19 patients requiring invasive mechanical ventilation regardless of their severity. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
1364-8535 |
| Relation: |
https://doaj.org/toc/1364-8535 |
| DOI: |
10.1186/s13054-022-03949-7 |
| Access URL: |
https://doaj.org/article/7c4feaba814b4836928e1c6b8c2ed7fc |
| Accession Number: |
edsdoj.7c4feaba814b4836928e1c6b8c2ed7fc |
| Database: |
Directory of Open Access Journals |
