Repositorio
Institucional

Cornejo, Rodrigo A.

Montoya, Jorge

Gajardo, Abraham I. J.

Graf, Jeronimo

Alegria, Leyla

Baghetti, Romyna

Irarrazaval, Anita

Santis, Cesar

Pavez, Nicolas

Leighton, Sofia

Tomicic, Vinko

Morales, Daniel

Ruiz, Carolina

Navarrete, Pablo

Vargas, Patricio

Galvez, Roberto

Espinosa, Victoria

Lazo, Marioli

Perez-Araos, Rodrigo A.

Garay, Osvaldo

Sepulveda, Patrick

Martinez, Edgardo

Bruhn, Alejandro

Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile

SPRINGER

ANNALS OF INTENSIVE CARE

en

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 PaO2: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 PaO2: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.

artículo original

10.1186/s13613-022-01082-w

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Acute respiratory distress syndrome

Mechanical ventilation

Prone positioning

Coronavirus disease 2019

RESPIRATORY-DISTRESS-SYNDROME

VENTILATION

SURVIVAL

FAILURE

TRIAL

Medicina de Terapia Intensiva

Síndrome de dificultad respiratoria aguda

Ventilación mecánica

Posicionamiento boca abajo

Enfermedad por coronavirus 2019

SÍNDROME DE DISTRIBUCIÓN-RESPIRATORIA

VENTILACIÓN

Supervivencia

FALLO

PRUEBA

Medicina de Emergencia y de Cuidados Críticos

Sistema Respiratorio

Otros Temas de Medicina Clínica

version publicada

dorada

verde

acceso abierto

acceso abierto

WOS:000889512900001

Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile

artículo original

CC BY 4.0

CC BY 4.0