NDLI: Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients

Content Provider	Springer Nature : BioMed Central
Author	Langer, Thomas Brioni, Matteo Guzzardella, Amedeo Carlesso, Eleonora Cabrini, Luca Castelli, Gianpaolo Dalla Corte, Francesca De Robertis, Edoardo Favarato, Martina Forastieri, Andrea Forlini, Clarissa Girardis, Massimo Grieco, Domenico Luca Mirabella, Lucia Noseda, Valentina Previtali, Paola Protti, Alessandro Rona, Roberto Tardini, Francesca Tonetti, Tommaso Zannoni, Fabio Antonelli, Massimo Foti, Giuseppe Ranieri, Marco Pesenti, Antonio Fumagalli, Roberto Grasselli, Giacomo
Abstract	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 PaO2/FiO2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position. 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 PaO2/FiO2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders. Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs. 38%, p = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders. These patients were older and had more comorbidities; however, no difference in terms of ICU mortality was observed (51% vs. 37%, p = 0.189 for Carbon Dioxide Responders and Non-Responders, respectively). 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
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/s13054-021-03552-2.pdf
Ending Page	11
Page Count	11
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/s13054-021-03552-2
Journal	Critical Care
Issue Number	1
Volume Number	25
Language	English
Publisher	BioMed Central
Publisher Date	2021-04-06
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine COVID-19 Mechanical ventilation Prone positioning Refractory hypoxemia
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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