Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients.
COVID-19
Mechanical ventilation
Prone positioning
Refractory hypoxemia
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
06 04 2021
06 04 2021
Historique:
received:
02
02
2021
accepted:
26
03
2021
entrez:
7
4
2021
pubmed:
8
4
2021
medline:
20
4
2021
Statut:
epublish
Résumé
Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p < 0.001). Overall, prone position induced a significant increase in PaO During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching. clinicaltrials.gov number: NCT04388670.
Sections du résumé
BACKGROUND
Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave.
METHODS
Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO
RESULTS
Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p < 0.001). Overall, prone position induced a significant increase in PaO
CONCLUSIONS
During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching.
TRIAL REGISTRATION
clinicaltrials.gov number: NCT04388670.
Identifiants
pubmed: 33823862
doi: 10.1186/s13054-021-03552-2
pii: 10.1186/s13054-021-03552-2
pmc: PMC8022297
doi:
Banques de données
ClinicalTrials.gov
['NCT04388670']
Types de publication
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
128Subventions
Organisme : Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
ID : Ricerca corrente 2020
Investigateurs
Angela Berselli
(A)
Tiziana Bove
(T)
Plinio Calligari
(P)
Irene Coloretti
(I)
Antonio Coluccello
(A)
Elena Costantini
(E)
Vito Fanelli
(V)
Giuseppe Gagliardi
(G)
Federico Longhini
(F)
Federica Mariani
(F)
Annalisa Mascarello
(A)
Luca Menga
(L)
Irene Ottaviani
(I)
Daniela Pasero
(D)
Matteo Pedeferri
(M)
Angelo Pezzi
(A)
Giuseppe Servillo
(G)
Paolo Severgnini
(P)
Savino Spadaro
(S)
Vanessa Zambelli
(V)
Références
N Engl J Med. 2013 Jun 6;368(23):2159-68
pubmed: 23688302
Euro Surveill. 2020 Apr;25(13):
pubmed: 32265003
JAMA. 2012 Jun 20;307(23):2526-33
pubmed: 22797452
Intensive Care Med. 2020 Dec;46(12):2385-2396
pubmed: 33169218
Br J Anaesth. 2009 May;102(5):692-7
pubmed: 19346233
Minerva Anestesiol. 2020 Nov;86(11):1234-1245
pubmed: 33228329
Am J Respir Crit Care Med. 2013 Dec 1;188(11):1286-93
pubmed: 24134414
N Engl J Med. 2001 Aug 23;345(8):568-73
pubmed: 11529210
JAMA. 1993 Dec 22-29;270(24):2957-63
pubmed: 8254858
JAMA Intern Med. 2020 Oct 1;180(10):1345-1355
pubmed: 32667669
JAMA. 2020 Apr 28;323(16):1574-1581
pubmed: 32250385
N Engl J Med. 2020 Feb 20;382(8):727-733
pubmed: 31978945
Br J Anaesth. 2021 Jan;126(1):48-55
pubmed: 33158500
JAMA. 2016 Feb 23;315(8):788-800
pubmed: 26903337
Lancet Respir Med. 2020 Dec;8(12):1201-1208
pubmed: 32861276
J Crit Care. 2015 Dec;30(6):1390-4
pubmed: 26271685
Eur Respir J. 2020 Jul 23;56(1):
pubmed: 32457195
Am J Respir Crit Care Med. 2014 Feb 15;189(4):494-6
pubmed: 24528322
J Appl Physiol (1985). 2013 Aug 1;115(3):313-24
pubmed: 23620488
Am J Respir Crit Care Med. 1994 Jul;150(1):184-93
pubmed: 8025748
Chest. 2020 Jun;157(6):1497-1505
pubmed: 32088180
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Intensive Care Med. 2020 Dec;46(12):2342-2356
pubmed: 33170331
Intensive Care Med. 2009 Jun;35(6):1011-7
pubmed: 19189081
Crit Care Med. 2003 Dec;31(12):2727-33
pubmed: 14668608
JAMA. 2020 Jun 9;323(22):2336-2338
pubmed: 32412581
Lancet Respir Med. 2020 Aug;8(8):765-774
pubmed: 32569585
Crit Care Med. 1985 Oct;13(10):818-29
pubmed: 3928249
Am J Respir Crit Care Med. 1998 Feb;157(2):387-93
pubmed: 9476848
Intensive Care Med. 2006 Dec;32(12):1987-93
pubmed: 17019539
JAMA. 2009 Nov 11;302(18):1977-84
pubmed: 19903918
Crit Care. 2011 Jul 25;15(4):R175
pubmed: 21791044
Crit Care Med. 1998 Nov;26(11):1793-800
pubmed: 9824069
Can Anaesth Soc J. 1981 Jul;28(4):370-2
pubmed: 6790141
Lancet Respir Med. 2020 Aug;8(8):744-745
pubmed: 32569584
Crit Care Med. 2020 Dec;48(12):1729-1736
pubmed: 33003079
Crit Care Med. 2021 Feb 17;:
pubmed: 33595960