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Multicenter Study
. 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  1 , Florian Sigaud  2 , Said Lebbah  3 , Luc Desmedt  4 , David Hajage  3 , Claude Guérin  5 , Jérôme Pugin  1 , Steve Primmaz  1 , Nicolas Terzi  6   7 ; COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
Collaborators, Affiliations
Multicenter Study

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 et al. Crit Care. .

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.

Keywords: Acute respiratory distress syndrome; COVID-19; Intensive care unit; Intubation; Mortality; Prone position.

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Conflict of interest statement

All authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart. ICU intensive care unit, PaO2 arterial partial pressure of oxygen, FiO2 fraction inspired of oxygen, PEEP positive end-expiratory pressure
Fig. 2
Fig. 2
a Kaplan–Meier curves according to prone status in ICU at Day-1 before weighting adjustment in complete case population. b Kaplan–Meier curves according to prone status in ICU at Day-1 after weighting adjustment in complete case population. ICU intensive care unit
Fig. 3
Fig. 3
a Forest plot: hazard ratio according to prone status in ICU at Day-1 before and after weighting in complete case population. b Hazard ratio according to prone status in ICU at Day-1 before and after weighting in baseline population. ICU intensive care unit, HR hazard ratio
See this image and copyright information in PMC

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References

    1. World Health Organization. Coronarovirus (COVID-19) dashboard. Available at https://covid19.who.int. Accessed 12 May 2022.
    1. Grasselli G, Greco M, Zanella A, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180(10):1345–1355. doi: 10.1001/jamainternmed.2020.3539. - DOI - PMC - PubMed
    1. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in critically ill patients in the Seattle Region—case series. N Engl J Med. 2020;382(21):2012–2022. doi: 10.1056/NEJMoa2004500. - DOI - PMC - PubMed
    1. COVID-ICU Group on behalf of the REVA network and the COVID-ICU investigators Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2021;47(1):60–73. doi: 10.1007/s00134-020-06294-x. - DOI - PMC - PubMed
    1. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. 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. - DOI - PMC - PubMed

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