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. 2024 Jun 27;14(1):100.
doi: 10.1186/s13613-024-01340-z.

Impact of intensive prone position therapy on outcomes in intubated patients with ARDS related to COVID-19

Christophe Le Terrier  1 , Thaïs Walter  2 , Said Lebbah  3 , David Hajage  3 , Florian Sigaud  4 , Claude Guérin  5 , Luc Desmedt  6 , Steve Primmaz  7 , Vincent Joussellin  8 , Chiara Della Badia  7 , Jean-Damien Ricard  9   10 , Jérôme Pugin  7 , Nicolas Terzi  8 ; COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
Collaborators, Affiliations

Impact of intensive prone position therapy on outcomes in intubated patients with ARDS related to COVID-19

Christophe Le Terrier et al. Ann Intensive Care. .

Erratum in

Abstract

Background: Previous retrospective research has shown that maintaining prone positioning (PP) for an average of 40 h is associated with an increase of survival rates in intubated patients with COVID-19-related acute respiratory distress syndrome (ARDS). This study aims to determine whether a cumulative PP duration of more than 32 h during the first 2 days of intensive care unit (ICU) admission is associated with increased survival compared to a cumulative PP duration of 32 h or less.

Methods: This study is an ancillary analysis from a previous large international observational study involving intubated patients placed in PP in the first 48 h of ICU admission in 149 ICUs across France, Belgium and Switzerland. Given that PP is recommended for a 16-h daily duration, intensive PP was defined as a cumulated duration of more than 32 h during the first 48 h, whereas standard PP was defined as a duration equal to or less than 32 h. Patients were followed-up for 90 days. The primary outcome was mortality at day 60. An Inverse Probability Censoring Weighting (IPCW) Cox model including a target emulation trial method was used to analyze the data.

Results: Out of 2137 intubated patients, 753 were placed in PP during the first 48 h of ICU admission. The intensive PP group (n = 79) had a median PP duration of 36 h, while standard PP group (n = 674) had a median of 16 h during the first 48 h. Sixty-day mortality rate in the intensive PP group was 39.2% compared to 38.7% in the standard PP group (p = 0.93). Twenty-eight-day and 90-day mortality as well as the ventilator-free days until day 28 were similar in both groups. After IPCW, there was no significant difference in mortality at day 60 between the two-study groups (HR 0.95 [0.52-1.74], p = 0.87 and HR 1.1 [0.77-1.57], p = 0.61 in complete case analysis or in multiple imputation analysis, respectively).

Conclusions: This secondary analysis of a large multicenter European cohort of intubated patients with ARDS due to COVID-19 found that intensive PP during the first 48 h did not provide a survival benefit compared to standard PP.

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

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Conflict of interest statement

All authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study flow chart. ICU intensive care unit
Fig. 2
Fig. 2
Empirical cumulative distribution function of the prone positioning duration during the first 48-h. ECDF:empirical cumulative distribution function
Fig. 3
Fig. 3
a Kaplan Meier curves according to prone positioning in the first 48-h after ICU admission before weighting adjustment in complete case population. b Kaplan Meier curves according to prone positioning in the first 48-h after ICU admission after weighting adjustment in complete case population. ICU intensive care unit
Fig. 4
Fig. 4
a Forest plot: hazard ratio of mortality at 60-day according to intensive prone positioning strategy in the first 48-h after ICU admission after weighting in baseline and complete case population. b Forest plot: hazard ratio of mortality at 28- and 90-day according to intensive prone positioning strategy in the first 48-h after ICU admission after weighting in baseline and complete case population. ICU intensive care unit, HR hazard ratio
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