tetano
Editor, Senior Moderator
Crit Care
. 2022 Mar 24;26(1):71.
doi: 10.1186/s13054-022-03949-7.
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
Christophe Le Terrier[SUP] 1 [/SUP], Florian Sigaud[SUP] 2 [/SUP], Said Lebbah[SUP] 3 [/SUP], Luc Desmedt[SUP] 4 [/SUP], David Hajage[SUP] 3 [/SUP], Claude Guérin[SUP] 5 [/SUP], Jérôme Pugin[SUP] 1 [/SUP], Steve Primmaz[SUP] 1 [/SUP], Nicolas Terzi[SUP] 6 7 [/SUP], COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
Collaborators, Affiliations
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 PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] 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.
Keywords: Acute respiratory distress syndrome; COVID-19; Intensive care unit; Intubation; Mortality; Prone position.
. 2022 Mar 24;26(1):71.
doi: 10.1186/s13054-022-03949-7.
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
Christophe Le Terrier[SUP] 1 [/SUP], Florian Sigaud[SUP] 2 [/SUP], Said Lebbah[SUP] 3 [/SUP], Luc Desmedt[SUP] 4 [/SUP], David Hajage[SUP] 3 [/SUP], Claude Guérin[SUP] 5 [/SUP], Jérôme Pugin[SUP] 1 [/SUP], Steve Primmaz[SUP] 1 [/SUP], Nicolas Terzi[SUP] 6 7 [/SUP], COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
Collaborators, Affiliations
- PMID: 35331332
- DOI: 10.1186/s13054-022-03949-7
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 PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] 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.
Keywords: Acute respiratory distress syndrome; COVID-19; Intensive care unit; Intubation; Mortality; Prone position.