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Multicenter Study
. 2023 Mar;163(3):533-542.
doi: 10.1016/j.chest.2022.10.034. Epub 2022 Nov 4.

Prolonged Prone Position Ventilation Is Associated With Reduced Mortality in Intubated COVID-19 Patients

Daniel Okin  1 , Ching-Ying Huang  1 , George A Alba  1 , Sirus J Jesudasen  2 , Nupur A Dandawate  3 , Alexander Gavralidis  3 , Leslie L Chang  2 , Emily E Moin  2 , Imama Ahmad  3 , Alison S Witkin  1 , C Corey Hardin  1 , Kathryn A Hibbert  1 , Aran Kadar  4 , Patrick L Gordan  5 , Hang Lee  2 , B Taylor Thompson  1 , Lisa M Bebell  2 , Peggy S Lai  6
Affiliations
Multicenter Study

Prolonged Prone Position Ventilation Is Associated With Reduced Mortality in Intubated COVID-19 Patients

Daniel Okin et al. Chest. 2023 Mar.

Abstract

Background: Prone position ventilation (PPV) is resource-intensive, yet the optimal strategy for PPV in intubated patients with COVID-19 is unclear.

Research question: Does a prolonged (24 or more h) PPV strategy improve mortality in intubated COVID-19 patients compared with intermittent (∼16 h with daily supination) PPV?

Study design and methods: Multicenter, retrospective cohort study of consecutively admitted intubated COVID-19 patients treated with PPV between March 11 and May 31, 2020. The primary outcome was 30-day all-cause mortality. Secondary outcomes included 90-day all-cause mortality and prone-related complications. Inverse probability treatment weights (IPTW) were used to control for potential treatment selection bias.

Results: Of the COVID-19 patients who received PPV, 157 underwent prolonged and 110 underwent intermittent PPV. Patients undergoing prolonged PPV had reduced 30-day (adjusted hazard ratio [aHR], 0.475; 95% CI, 0.336-0.670; P < .001) and 90-day (aHR, 0.638; 95% CI, 0.461-0.883; P = .006) mortality compared with intermittent PPV. In patients with Pao2/Fio2 ≤ 150 at the time of pronation, prolonged PPV was associated with reduced 30-day (aHR, 0.357; 95% CI, 0.213-0.597; P < .001) and 90-day mortality (aHR, 0.562; 95% CI, 0.357-0.884; P = .008). Patients treated with prolonged PPV underwent fewer pronation and supination events (median, 1; 95% CI, 1-2 vs 3; 95% CI, 1-4; P < .001). PPV strategy was not associated with overall PPV-related complications, although patients receiving prolonged PPV had increased rates of facial edema and lower rates of peri-proning hypotension.

Interpretation: Among intubated COVID-19 patients who received PPV, prolonged PPV was associated with reduced mortality. Prolonged PPV was associated with fewer pronation and supination events and a small increase in rates of facial edema. These findings suggest that prolonged PPV is a safe, effective strategy for mortality reduction in intubated COVID-19 patients.

Keywords: COVID-19; acute hypoxemic respiratory failure; mechanical ventilation; prone position ventilation.

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Figures

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Graphical abstract
Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Kaplan-Meier plot of the probability of survival from time of proning to 90 days in (A) the entire cohort and (B) patients with Pao2/Fio2 ≤ 150 at time of pronation.
See this image and copyright information in PMC

Comment in

References

    1. Kim L., Garg S., O’Halloran A., et al. Risk factors for intensive care unit admission and in-hospital mortality among hospitalized adults identified through the U.S. coronavirus disease 2019 (COVID-19)-associated hospitalization surveillance network (COVID-NET) Clin Infect Dis. 2020 ciaa1012. - PMC - PubMed
    1. Ferrando C., Suarez-Sipmann F., Mellado-Artigas R., et al. Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Med. 2020;46(12):2200–2211. - PMC - PubMed
    1. Auld S.C., Caridi-Scheible M., Blum J.M., et al. ICU and ventilator mortality among critically ill adults with coronavirus disease 2019. Crit Care Med. 2020;(9):48. doi: 10.1097/CCM.0000000000004457. - DOI - PMC - PubMed
    1. Buffières W., Sarton B., Zadro C., et al. Clinical course and risk factors for severe disease and death of adult critically ill inpatients with COVID-19 in Toulouse, France: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. - PMC - PubMed
    1. Ziehr D.R., Alladina J., Petri C.R., et al. Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study. Am J Respir Crit Care. 2020;0(ja):1560–1564. - PMC - PubMed

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