Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile.
Acute respiratory distress syndrome
Coronavirus disease 2019
Mechanical ventilation
Prone positioning
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
28 Nov 2022
28 Nov 2022
Historique:
received:
18
08
2022
accepted:
06
11
2022
entrez:
28
11
2022
pubmed:
29
11
2022
medline:
29
11
2022
Statut:
epublish
Résumé
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. 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 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 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.
Sections du résumé
BACKGROUND
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
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
RESULTS
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
CONCLUSIONS
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.
Identifiants
pubmed: 36441352
doi: 10.1186/s13613-022-01082-w
pii: 10.1186/s13613-022-01082-w
pmc: PMC9702866
doi:
Types de publication
Journal Article
Langues
eng
Pagination
109Investigateurs
Nicole Rossel
(N)
María José Martin
(MJ)
Juan Nicolás Medel
(JN)
Vanessa Oviedo
(V)
Magdalena Vera
(M)
Vicente Torres
(V)
José Miguel Montes
(JM)
Álvaro Salazar
(Á)
Carla Muñoz
(C)
Francisca Tala
(F)
Mariana Migueles
(M)
Claudia Ortiz
(C)
Felipe Gómez
(F)
Luis Contreras
(L)
Itzia Daviu
(I)
Yurimar Rodriguez
(Y)
Carol Ortiz
(C)
Andrés Aquevedo
(A)
Rodrigo Parada
(R)
Cristián Vargas
(C)
Miguel Gatica
(M)
Dalia Guerrero
(D)
Araceli Valenzuela
(A)
Diego Torrejón
(D)
Informations de copyright
© 2022. The Author(s).
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