Practice of Awake Prone Positioning in Critically Ill COVID-19 Patients-Insights from the PRoAcT-COVID Study

Willemke Stilma^{1

2}, Christel M A Valk¹, David M P van Meenen^{1

3}, Luis Morales^{4

5}, Daantje Remmelzwaal¹, Sheila N Myatra⁶, Antonio Artigas^{7

8}, Ary Serpa Neto^{9

10}, Frederique Paulus^{1

2}, Marcus J Schultz^{1

11

12}; PRoAcT–COVID Collaborative Group

Collaborators, Affiliations

Collaborators

PRoAcT–COVID Collaborative Group:
E Aydeniz, P van de Berg, D C Bergmans, M Bevers, S den Boer, L S Boers, L D J Bos, M Botta, L A Buiteman-Kruizinga, W Coene, M Delmte, V Di Leo, D A Dongelmans, T P Dormans, L M Elting, A A Esmeijer, M Gama de Abreu, A R Girbes, M J de Graaff, D M Go, R L Goossen, H J Hansen, J J Haringman, P L van der Heiden, L Hol, M W Hollmann, J Horn, L E van Ingen, N P Juffermans, E Koornstra, M A Kuiper, L J Kuipers, A Lokhorst, I Martin–Loeches, G Mazzinari, S N Myatra, G S L H Nijbroek, M Offermans, P van Oosten, F Paulus, T Pisters, A Prins, J Pillay, I M Purmer, A S Rezaee, T C D Rettig, O Roca, N M Rosenberg, N Schavemaker, M J Schultz, A A Sciascera, A Serpa Neto, G Sherstha, M E Sleeswijk, P E Spronk, W Stilma, A C Strang, A M Tsonas, P R Tuinman, C M A Valk, M Verboom, A P Vlaar, P van Velzen, W H van der Ven, F L van der Ven, E J Verhoef, T D Vermeulen, P van Vliet, J J J S Voorham, P H van der Voort, N Weiner, N Yaali, J M Zandvliet, A R van Zanten, T Z van Zijl, S A Zonneveld

Affiliations

¹ Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', 1105 AZ Amsterdam, The Netherlands.
² Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands.
³ Department of Anesthesiology, Amsterdam University Medical Centers, Location 'AMC', 1105 AZ Amsterdam, The Netherlands.
⁴ Servei de Medicina Intensiva, Hospital Universitari Sant Pau, 08025 Barcelona, Spain.
⁵ Translational Research Laboratory, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona Sabadell, 08208 Barcelona, Spain.
⁶ Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India.
⁷ Intensive Care Department, CIBER Enfermedades Respiratorias, Parc Tauli University Hospital, 08208 Sabadell, Spain.
⁸ Autonomous University of Barcelona, 08193 Sabadell, Spain.
⁹ Australian and New Zealand Intensive Care, Research Center (ANZIC-RC), Monash University, Melbourne 3800, Australia.
¹⁰ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil.
¹¹ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK.
¹² Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.

PMID: 36498564
PMCID: PMC9739110
DOI: 10.3390/jcm11236988

Practice of Awake Prone Positioning in Critically Ill COVID-19 Patients-Insights from the PRoAcT-COVID Study

Willemke Stilma et al. J Clin Med. 2022.

. 2022 Nov 26;11(23):6988.

doi: 10.3390/jcm11236988.

Authors

Collaborators

PRoAcT–COVID Collaborative Group:
E Aydeniz, P van de Berg, D C Bergmans, M Bevers, S den Boer, L S Boers, L D J Bos, M Botta, L A Buiteman-Kruizinga, W Coene, M Delmte, V Di Leo, D A Dongelmans, T P Dormans, L M Elting, A A Esmeijer, M Gama de Abreu, A R Girbes, M J de Graaff, D M Go, R L Goossen, H J Hansen, J J Haringman, P L van der Heiden, L Hol, M W Hollmann, J Horn, L E van Ingen, N P Juffermans, E Koornstra, M A Kuiper, L J Kuipers, A Lokhorst, I Martin–Loeches, G Mazzinari, S N Myatra, G S L H Nijbroek, M Offermans, P van Oosten, F Paulus, T Pisters, A Prins, J Pillay, I M Purmer, A S Rezaee, T C D Rettig, O Roca, N M Rosenberg, N Schavemaker, M J Schultz, A A Sciascera, A Serpa Neto, G Sherstha, M E Sleeswijk, P E Spronk, W Stilma, A C Strang, A M Tsonas, P R Tuinman, C M A Valk, M Verboom, A P Vlaar, P van Velzen, W H van der Ven, F L van der Ven, E J Verhoef, T D Vermeulen, P van Vliet, J J J S Voorham, P H van der Voort, N Weiner, N Yaali, J M Zandvliet, A R van Zanten, T Z van Zijl, S A Zonneveld

Affiliations

¹ Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', 1105 AZ Amsterdam, The Netherlands.
² Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands.
³ Department of Anesthesiology, Amsterdam University Medical Centers, Location 'AMC', 1105 AZ Amsterdam, The Netherlands.
⁴ Servei de Medicina Intensiva, Hospital Universitari Sant Pau, 08025 Barcelona, Spain.
⁵ Translational Research Laboratory, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona Sabadell, 08208 Barcelona, Spain.
⁶ Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India.
⁷ Intensive Care Department, CIBER Enfermedades Respiratorias, Parc Tauli University Hospital, 08208 Sabadell, Spain.
⁸ Autonomous University of Barcelona, 08193 Sabadell, Spain.
⁹ Australian and New Zealand Intensive Care, Research Center (ANZIC-RC), Monash University, Melbourne 3800, Australia.
¹⁰ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil.
¹¹ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK.
¹² Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.

PMID: 36498564
PMCID: PMC9739110
DOI: 10.3390/jcm11236988

Abstract

We describe the incidence, practice and associations with outcomes of awake prone positioning in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) in a national multicenter observational cohort study performed in 16 intensive care units in the Netherlands (PRoAcT−COVID-study). Patients were categorized in two groups, based on received treatment of awake prone positioning. The primary endpoint was practice of prone positioning. Secondary endpoint was ‘treatment failure’, a composite of intubation for invasive ventilation and death before day 28. We used propensity matching to control for observed confounding factors. In 546 patients, awake prone positioning was used in 88 (16.1%) patients. Prone positioning started within median 1 (0 to 2) days after ICU admission, sessions summed up to median 12.0 (8.4−14.5) hours for median 1.0 day. In the unmatched analysis (HR, 1.80 (1.41−2.31); p < 0.001), but not in the matched analysis (HR, 1.17 (0.87−1.59); p = 0.30), treatment failure occurred more often in patients that received prone positioning. The findings of this study are that awake prone positioning was used in one in six COVID-19 patients. Prone positioning started early, and sessions lasted long but were often discontinued because of need for intubation.

Keywords: COVID-19; acute hypoxemic respiratory failure; awake prone positioning; coronavirus disease 2019; outcome; prone positioning; propensity matching; self-proning.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

**Figure 1**
Flow chart of patient inclusion.

**Figure 2**
Patient outcomes in the unmatched (**left** panel) and the matched analysis (**right** panel).

See this image and copyright information in PMC

References

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Practice of Awake Prone Positioning in Critically Ill COVID-19 Patients-Insights from the PRoAcT-COVID Study

Collaborators

Affiliations

Practice of Awake Prone Positioning in Critically Ill COVID-19 Patients-Insights from the PRoAcT-COVID Study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources