Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile - 08/01/26
, Jorge Montoya 1, *, Abraham I.J. Gajardo 1, Jerónimo Graf 2, 3, Leyla Alegría 4, Romyna Baghetti 5, Anita Irarrázaval 6, César Santis 7, 8, Nicolás Pavez 9, 10, Sofía Leighton 11, Vinko Tomicic 12, 13, Daniel Morales 14, Carolina Ruiz 4, 15, Pablo Navarrete 16, Patricio Vargas 17, 18, Roberto Gálvez 19, Victoria Espinosa 20, 21, Marioli Lazo 1, Rodrigo A. Pérez-Araos 2, 3, Osvaldo Garay 5, Patrick Sepúlveda 6, Edgardo Martinez 11, Alejandro Bruhn 4, 22, * the SOCHIMI Prone-COVID-19 Group
Nicole Rossel, María José Martin, Juan Nicolás Medel, Vanessa Oviedo, Magdalena Vera, Vicente Torres, José Miguel Montes, Álvaro Salazar, Carla Muñoz, Francisca Tala, Mariana Migueles, Claudia Ortiz, Felipe Gómez, Luis Contreras, Itzia Daviu, Yurimar Rodriguez, Carol Ortiz, Andrés Aquevedo, Rodrigo Parada, Cristián Vargas, Miguel Gatica, Dalia Guerrero, Araceli Valenzuela, Diego Torrejón
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Abstract |
Background |
Prone positioning is currently applied in time-limited daily sessions up to 24 h which determines that most patients require several sessions. Although longer prone sessions have been reported, there is scarce evidence about the feasibility and safety of such approach. We analyzed feasibility and safety of a continuous prolonged prone positioning strategy implemented nationwide, in a large cohort of COVID-19 patients in Chile.
Methods |
Retrospective cohort study of mechanically ventilated COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted in 15 Intensive Care Units, which adhered to a national protocol of continuous prone sessions ≥ 48 h and until PaO 2 :FiO 2 increased above 200 mm Hg. The number and extension of prone sessions were registered, along with relevant physiologic data and adverse events related to prone positioning. The cohort was stratified according to the first prone session duration: Group A, 2–3 days; Group B, 4–5 days; and Group C, > 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety.
Results |
We included 417 patients who required a first prone session of 4 (3–5) days, of whom 318 (76.3%) received only one session. During the first prone session the main adverse event was grade 1–2 pressure sores in 97 (23.9%) patients; severe adverse events were infrequent with 17 non-scheduled extubations (4.2%). 90-day mortality was 36.2%. Ninety-eight patients (24%) were classified as group C; they exhibited a more severe ARDS at baseline, as reflected by lower PaO 2 :FiO 2 ratio and higher ventilatory ratio, and had a higher rate of pressure sores (44%) and higher 90-day mortality (48%). However, after adjustment for severity and several relevant confounders, prone session duration was not associated with mortality or pressure sores.
Conclusions |
Nationwide implementation of a continuous prolonged prone positioning strategy for COVID-19 ARDS patients was feasible. Minor pressure sores were frequent but within the ranges previously described, while severe adverse events were infrequent. The duration of prone session did not have an adverse effect on safety.
Le texte complet de cet article est disponible en PDF.Keywords : Acute respiratory distress syndrome, Mechanical ventilation, Prone positioning, Coronavirus disease 2019
Keywords : Medical and Health Sciences, Clinical Sciences
Plan
Vol 12 - N° 1
Article 109- 2022 Retour au numéro
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