Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Mar 9:78:100180.
doi: 10.1016/j.clinsp.2023.100180. eCollection 2023.

Aging-related predictive factors for oxygenation improvement and mortality in COVID-19 and acute respiratory distress syndrome (ARDS) patients exposed to prone position: A multicenter cohort study

Marieta C A Cunha  1 , Jociane Schardong  2 , Natiele C Righi  2 , Adriana C Lunardi  3 , Guadalupe N Sant'Anna  3 , Larissa P Isensee  3 , Rafaela F Xavier  3 , Jose E Pompeu  3 , Renata M Weigert  4 , Darlan L Matte  5 , Rozana A Cardoso  6 , Ana C V Abras  6 , Antonio M V Silva  7 , Camila C Dorneles  8 , Roberta W Werle  8 , Ana C Starke  9 , Juliana C Ferreira  1 , Rodrigo D M Plentz  2 , Celso R F Carvalho  10
Affiliations
Multicenter Study

Aging-related predictive factors for oxygenation improvement and mortality in COVID-19 and acute respiratory distress syndrome (ARDS) patients exposed to prone position: A multicenter cohort study

Marieta C A Cunha et al. Clinics (Sao Paulo). .

Abstract

Background: Elderly patients are more susceptible to Coronavirus Disease-2019 (COVID-19) and are more likely to develop it in severe forms, (e.g., Acute Respiratory Distress Syndrome [ARDS]). Prone positioning is a treatment strategy for severe ARDS; however, its response in the elderly population remains poorly understood. The main objective was to evaluate the predictive response and mortality of elderly patients exposed to prone positioning due to ARDS-COVID-19.

Methods: This retrospective multicenter cohort study involved 223 patients aged ≥ 65 years, who received prone position sessions for severe ARDS due to COVID-19, using invasive mechanical ventilation. The PaO2/FiO2 ratio was used to assess the oxygenation response. The 20-point improvement in PaO2/FiO2 after the first prone session was considered for good response. Data were collected from electronic medical records, including demographic data, laboratory/image exams, complications, comorbidities, SAPS III and SOFA scores, use of anticoagulants and vasopressors, ventilator settings, and respiratory system mechanics. Mortality was defined as deaths that occurred until hospital discharge.

Results: Most patients were male, with arterial hypertension and diabetes mellitus as the most prevalent comorbidities. The non-responders group had higher SAPS III and SOFA scores, and a higher incidence of complications. There was no difference in mortality rate. A lower SAPS III score was a predictor of oxygenation response, and the male sex was a risk predictor of mortality.

Conclusion: The present study suggests the oxygenation response to prone positioning in elderly patients with severe COVID-19-ARDS correlates with the SAPS III score. Furthermore, the male sex is a risk predictor of mortality.

Keywords: Acute respiratory distress syndrome; Adult respiratory distress syndrome; COVID-19; Coronavirus infections; Prone position.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest The authors declare no conflicts of interest.

References

    1. ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526–2533. - PubMed
    1. Meftahi GH, Jangravi Z, Sahraei H, Bahari Z. The possible pathophysiology mechanism of cytokine storm in elderly adults with COVID-19 infection: the contribution of “inflame-aging”. Inflamm Res. 2020;69(9):825–839. - PMC - PubMed
    1. Mahida RY, Chotalia M, Alderman J, Patel C, Hayden A, Desai R, et al. Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a single-centre experience. BMJ Open Respir Res. 2020;7(1) - PMC - PubMed
    1. Gibson PG, Qin L, Puah SH. COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS. Med J. 2020;213(2):54–56. - PMC - PubMed
    1. Alhazzani W, Evans L, Alshamsi F, Moller MH, Ostermann M, Prescott HC, et al. Surviving sepsis campaign guidelines on the management of adults with coronavirus disease 2019 (COVID-19) in the ICU: first update. Crit Care Med. 2021;149(3):e219–e234. - PubMed

Publication types