Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study - 08/01/26
The ICU-RER COVID-19 Collaboration
Marco Tartaglione, Valentina Chiarini, Virginia Buldini, Carlo Coniglio, Federico Moro, Clara Barbalace, Mario Citino, Nicola Cilloni, Lorenzo Giuntoli, Angela Bellocchio, Emanuele Matteo, Giacinto Pizzilli, Antonio Siniscalchi, Chiara Tartivita, Francesco Matteo, Annalisa Marchio, Igor Bacchilega, Laura Bernabé, Sonia Guarino, Elena Mosconi, Luca Bissoni, Lorenzo Viola, Tommaso Meconi, Vittorio Pavoni, Aline Pagni, Patrizia Pompa Cleta, Marco Cavagnino, Anna Malfatto, Angelina Adduci, Silvia Pareschi, Gabriele Melegari, Jessica Maccieri, Elisa Marinangeli, Fabrizio Racca, Marco Verri, Giulia Falò, Elisabetta Marangoni, Francesco Boni, Giulia Felloni, Federico Domenico Baccarini, Marina Terzitta, Stefano Maitan, Filippo Becherucci, Maddalena Parise, Francesca Masoni, Michele Imbriani, Paolo Orlandi, Francesco Monetti, Giorgia Dalpiaz, Rita Golfieri, Federica Ciccarese, Antonio Poerio, Francesco Muratore, Fabio Ferrari, Martina Mughetti, Loredana Franchini, Ersenad Neziri, Marco Miceli, Maria resa Te Minguzzi, Lorenzo Mellini, Sara Piciucchi, Maurizio Bartolucci
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Abstract |
Background |
Prone positioning (PP) has been used to improve oxygenation in patients affected by the SARS-CoV-2 disease (COVID-19). Several mechanisms, including lung recruitment and better lung ventilation/perfusion matching, make a relevant rational for using PP. However, not all patients maintain the oxygenation improvement after returning to supine position. Nevertheless, no evidence exists that a sustained oxygenation response after PP is associated to outcome in mechanically ventilated COVID-19 patients. We analyzed data from 191 patients affected by COVID-19-related acute respiratory distress syndrome undergoing PP for clinical reasons. Clinical history, severity scores and respiratory mechanics were analyzed. Patients were classified as responders (≥ median PaO 2 /FiO 2 variation) or non-responders ( < median PaO 2 /FiO 2 variation) based on the PaO 2 /FiO 2 percentage change between pre-proning and 1 to 3 h after re-supination in the first prone positioning session. Differences among the groups in physiological variables, complication rates and outcome were evaluated. A competing risk regression analysis was conducted to evaluate if PaO 2 /FiO 2 response after the first pronation cycle was associated to liberation from mechanical ventilation.
Results |
The median PaO 2 /FiO 2 variation after the first PP cycle was 49 [19–100%] and no differences were found in demographics, comorbidities, ventilatory treatment and PaO 2 /FiO 2 before PP between responders (96/191) and non-responders (95/191). Despite no differences in ICU length of stay, non-responders had a higher rate of tracheostomy (70.5% vs 47.9, P = 0.008) and mortality (53.7% vs 33.3%, P = 0.006), as compared to responders. Moreover, oxygenation response after the first PP was independently associated to liberation from mechanical ventilation at 28 days and was increasingly higher being higher the oxygenation response to PP.
Conclusions |
Sustained oxygenation improvement after first PP session is independently associated to improved survival and reduced duration of mechanical ventilation in critically ill COVID-19 patients.
Le texte complet de cet article est disponible en PDF.Keywords : COVID19, Prone positioning, Ventilatory free days, ICU
Plan
Vol 11 - N° 1
Article 63- 2021 Retour au numéro
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