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Impact of intensive prone position therapy on outcomes in intubated patients with ARDS related to COVID-19.
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- Author(s): Le Terrier, Christophe; Walter, Thaïs; Lebbah, Said; Hajage, David; Sigaud, Florian; Guérin, Claude; Desmedt, Luc; Primmaz, Steve; Jousselin, Vincent; Della Badia, Chiara; Ricard, Jean-Damien; Pugin, Jérôme; Terzi, Nicolas; COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators; Mercat, Alain; Asfar, Pierre; Beloncle, François; Demiselle, Julien; Pham, Tài; Pavot, Arthur
- Source:
Annals of Intensive Care; 6/27/2024, Vol. 14 Issue 1, p1-14, 14p- Subject Terms:
ADULT respiratory distress syndrome; CRITICALLY ill; PATIENTS; T-test (Statistics); LYING down position; FISHER exact test; TREATMENT duration; TREATMENT effectiveness; REVERSE transcriptase polymerase chain reaction; MANN Whitney U Test; DESCRIPTIVE statistics; LONGITUDINAL method; INTENSIVE care units; RESEARCH; SURVIVAL analysis (Biometry); CONFIDENCE intervals; COVID-19 - Source:
- Additional Information
- Subject Terms:
- Abstract: Background: Previous retrospective research has shown that maintaining prone positioning (PP) for an average of 40 h is associated with an increase of survival rates in intubated patients with COVID-19-related acute respiratory distress syndrome (ARDS). This study aims to determine whether a cumulative PP duration of more than 32 h during the first 2 days of intensive care unit (ICU) admission is associated with increased survival compared to a cumulative PP duration of 32 h or less. Methods: This study is an ancillary analysis from a previous large international observational study involving intubated patients placed in PP in the first 48 h of ICU admission in 149 ICUs across France, Belgium and Switzerland. Given that PP is recommended for a 16-h daily duration, intensive PP was defined as a cumulated duration of more than 32 h during the first 48 h, whereas standard PP was defined as a duration equal to or less than 32 h. Patients were followed-up for 90 days. The primary outcome was mortality at day 60. An Inverse Probability Censoring Weighting (IPCW) Cox model including a target emulation trial method was used to analyze the data. Results: Out of 2137 intubated patients, 753 were placed in PP during the first 48 h of ICU admission. The intensive PP group (n = 79) had a median PP duration of 36 h, while standard PP group (n = 674) had a median of 16 h during the first 48 h. Sixty-day mortality rate in the intensive PP group was 39.2% compared to 38.7% in the standard PP group (p = 0.93). Twenty-eight-day and 90-day mortality as well as the ventilator-free days until day 28 were similar in both groups. After IPCW, there was no significant difference in mortality at day 60 between the two-study groups (HR 0.95 [0.52–1.74], p = 0.87 and HR 1.1 [0.77–1.57], p = 0.61 in complete case analysis or in multiple imputation analysis, respectively). Conclusions: This secondary analysis of a large multicenter European cohort of intubated patients with ARDS due to COVID-19 found that intensive PP during the first 48 h did not provide a survival benefit compared to standard PP. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Annals of Intensive Care is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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