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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2022

Open Access 01-12-2022 | Acute Respiratory Distress-Syndrome | Research

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

Authors: Rodrigo A. Cornejo, Jorge Montoya, Abraham I. J. Gajardo, Jerónimo Graf, Leyla Alegría, Romyna Baghetti, Anita Irarrázaval, César Santis, Nicolás Pavez, Sofía Leighton, Vinko Tomicic, Daniel Morales, Carolina Ruiz, Pablo Navarrete, Patricio Vargas, Roberto Gálvez, Victoria Espinosa, Marioli Lazo, Rodrigo A. Pérez-Araos, Osvaldo Garay, Patrick Sepúlveda, Edgardo Martinez, Alejandro Bruhn, the SOCHIMI Prone-COVID-19 Group

Published in: Annals of Intensive Care | Issue 1/2022

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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 PaO2:FiO2 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:FiO2 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.
Appendix
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Literature
1.
Guérin C, Reignier J, Richard J-C, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;23(6):2159–68.CrossRef
2.
Guérin C, Beuret P, Constantin JM, Bellani G, Garcia-Olivares P, Roca O, et al. A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study. Intensive Care Med. 2018;44(1):22–37.CrossRefPubMed
3.
4.
Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med. 2001;345(8):568–73.CrossRefPubMed
5.
McAuley D, Giles S, Fichter H, Perkins G, Gao F. What is the optimal duration of ventilation in the prone position in acute lung injury and acute respiratory distress syndrome? Intensive Care Med. 2002;28(4):414–8.CrossRefPubMed
6.
Mancebo J, Fernández R, Blanch L, Rialp G, Gordo F, Ferrer M, et al. A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006;173(11):1233–9.CrossRefPubMed
7.
Taccone P, Pesenti A, Latini R, Polli F, Vagginelli F, Mietto C, et al. Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. JAMA - J Am Med Assoc. 2009;302(18):1977–84.CrossRef
8.
Langer T, Brioni M, Guzzardella A, Carlesso E, Cabrini L, Castelli G, et al. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients. Crit Care. 2021;25(1):1–11.CrossRef
9.
Estenssoro E, Loudet CI, Ríos FG, Kanoore Edul VS, Plotnikow G, Andrian M, et al. Clinical characteristics and outcomes of invasively ventilated patients with COVID-19 in Argentina (SATICOVID): a prospective, multicentre cohort study. Lancet Respir Med. 2021;9(9):989–98.CrossRefPubMedPubMedCentral
10.
Patel BV, Haar S, Handslip R, Auepanwiriyakul C, Lee TML, Patel S, et al. Natural history, trajectory, and management of mechanically ventilated COVID-19 patients in the United Kingdom. Intensive Care Med. 2021;47(5):549–65.CrossRefPubMedPubMedCentral
11.
Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the berlin definition. JAMA. 2012;307(23):2526–33.PubMed
12.
13.
Stilma W, Van Meenen DMP, Valk CMA, De Bruin H, Paulus F, Neto AS, et al. Incidence and practice of early prone positioning in invasively ventilated COVID-19 patients—insights from the PRoVENTCOVID observational study. J Clin Med. 2021;10(20):4783.CrossRefPubMedPubMedCentral
14.
Carsetti A, Paciarini AD, Marini B, Pantanetti S, Adrario E, Donati A. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective. Crit Care. 2020;24:1–3.CrossRef
15.
16.
17.
Cornejo RA, Diaz JC, Tobar EA, Bruhn AR, Ramos CA, Gonzalez RA, et al. Effects of prone positioning on lung protection in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2013;188(4):440–8.CrossRefPubMed
18.
Romero CM, Cornejo RA, Gálvez LR, Llanos OP, Tobar EA, Berasaín MA, et al. Extended prone position ventilation in severe acute respiratory distress syndrome: a pilot feasibility study. J Crit Care. 2009;24(1):81–8.CrossRefPubMed
19.
Chan M-C, Hsu J-Y, Liu H-H, Lee Y-L, Pong S-C, Chang L-Y, et al. Effects of prone position on inflammatory markers in patients with ARDS due to community-acquired pneumonia. J Formos Med Assoc. 2007;106(9):708–16.CrossRefPubMed
20.
Cornejo R, Tobar E, Díaz G, Romero C, Llanos O, Gálvez LR, et al. Systematic approach for severe respiratory failure due to novel a (H1N1) influenza. Minerva Anestesiol. 2011;77(5):510–21.PubMed
21.
Sinha P, Calfee CS, Beitler JR, Soni N, Ho K, Matthay MA, et al. Physiologic analysis and clinical performance of the ventilatory ratio in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2019;199(3):333–41.CrossRefPubMedPubMedCentral
22.
23.
Black J, Baharestani M, Cuddigan J, Dorner B, Edsberg L, Langemo D, et al. National Pressure Ulcer Advisory Panel’s updated pressure ulcer staging system. Dermatol Nurs. 2007;19(4):343–9.PubMed
24.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7.CrossRef
25.
Schmidt M, Hajage D, Demoule A, Pham T, Combes A, Dres M, et al. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2021;47(1):60–73.CrossRef
26.
Douglas IS, Rosenthal CA, Swanson DD, Hiller T, Oakes J, Bach J, Whelchel C, Pickering J, George T, Kearns M, Hanley M. Safety and outcomes of prolonged usual care prone position mechanical ventilation to treat acute coronavirus disease 2019 hypoxemic respiratory failure. Crit Care Med. 2021;49(3):490–502.CrossRefPubMed
27.
Girard R, Baboi L, Ayzac L, Richard JC, Guérin C. The impact of patient positioning on pressure ulcers in patients with severe ARDS: results from a multicentre randomised controlled trial on prone positioning. Intensive Care Med. 2014;40(3):397–403.CrossRefPubMed
28.
Lucchini A, Russotto V, Barreca N, Villa M, Casartelli G, Marcolin Y, et al. Short and long-term complications due to standard and extended prone position cycles in CoViD-19 patients. Intensive Crit Care Nurs. 2021;2022(69): 103158.
29.
Ibarra G, Rivera A, Fernandez-Ibarburu B, Lorca-García C, Garcia-Ruano A. Prone position pressure sores in the COVID-19 pandemic: the Madrid experience. J Plast Reconstr Aesthetic Surg. 2021;74(9):2141–8.CrossRef
30.
Albert RK, Keniston A, Baboi L, Ayzac L, Guérin C. Proseva investigators. Prone position-induced improvement in gas exchange does not predict improved survival in the acute respiratory distress syndrome. Am J Respir Crit Care Med. 2014;189(4):494–6.CrossRefPubMed
31.
Parker EM, Bittner EA, Berra L, Pino RM. Efficiency of prolonged prone positioning for mechanically ventilated patients infected with covid-19. J Clin Med. 2021;10(13):2969.CrossRefPubMedPubMedCentral
Metadata
Title
Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile
Authors
Rodrigo A. Cornejo
Jorge Montoya
Abraham I. J. Gajardo
Jerónimo Graf
Leyla Alegría
Romyna Baghetti
Anita Irarrázaval
César Santis
Nicolás Pavez
Sofía Leighton
Vinko Tomicic
Daniel Morales
Carolina Ruiz
Pablo Navarrete
Patricio Vargas
Roberto Gálvez
Victoria Espinosa
Marioli Lazo
Rodrigo A. Pérez-Araos
Osvaldo Garay
Patrick Sepúlveda
Edgardo Martinez
Alejandro Bruhn
the SOCHIMI Prone-COVID-19 Group
Publication date
01-12-2022
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2022
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-022-01082-w

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