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

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 feasibi...

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Published in:Annals of intensive care 2022-11, Vol.12 (1), p.109-109, Article 109
Main Authors: Cornejo, Rodrigo A., Montoya, Jorge, Gajardo, Abraham I. J., Graf, Jerónimo, Alegría, Leyla, Baghetti, Romyna, Irarrázaval, Anita, Santis, César, Pavez, Nicolás, Leighton, Sofía, Tomicic, Vinko, Morales, Daniel, Ruiz, Carolina, Navarrete, Pablo, Vargas, Patricio, Gálvez, Roberto, Espinosa, Victoria, Lazo, Marioli, Pérez-Araos, Rodrigo A., Garay, Osvaldo, Sepúlveda, Patrick, Martinez, Edgardo, Bruhn, Alejandro
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cited_by cdi_FETCH-LOGICAL-c584t-de72fa250baf1a36845c33b15514e5b0b04a1fc7fcc9feb300a49d894c6c4dea3
cites cdi_FETCH-LOGICAL-c584t-de72fa250baf1a36845c33b15514e5b0b04a1fc7fcc9feb300a49d894c6c4dea3
container_end_page 109
container_issue 1
container_start_page 109
container_title Annals of intensive care
container_volume 12
creator Cornejo, Rodrigo A.
Montoya, Jorge
Gajardo, Abraham I. J.
Graf, Jerónimo
Alegría, Leyla
Baghetti, Romyna
Irarrázaval, Anita
Santis, César
Pavez, Nicolás
Leighton, Sofía
Tomicic, Vinko
Morales, Daniel
Ruiz, Carolina
Navarrete, Pablo
Vargas, Patricio
Gálvez, Roberto
Espinosa, Victoria
Lazo, Marioli
Pérez-Araos, Rodrigo A.
Garay, Osvaldo
Sepúlveda, Patrick
Martinez, Edgardo
Bruhn, Alejandro
description 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 PaO 2 :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 PaO 2 :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.
doi_str_mv 10.1186/s13613-022-01082-w
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J. ; Graf, Jerónimo ; Alegría, Leyla ; Baghetti, Romyna ; Irarrázaval, Anita ; Santis, César ; Pavez, Nicolás ; Leighton, Sofía ; Tomicic, Vinko ; Morales, Daniel ; Ruiz, Carolina ; Navarrete, Pablo ; Vargas, Patricio ; Gálvez, Roberto ; Espinosa, Victoria ; Lazo, Marioli ; Pérez-Araos, Rodrigo A. ; Garay, Osvaldo ; Sepúlveda, Patrick ; Martinez, Edgardo ; Bruhn, Alejandro</creator><creatorcontrib>Cornejo, Rodrigo A. ; Montoya, Jorge ; Gajardo, Abraham I. J. ; Graf, Jerónimo ; Alegría, Leyla ; Baghetti, Romyna ; Irarrázaval, Anita ; Santis, César ; Pavez, Nicolás ; Leighton, Sofía ; Tomicic, Vinko ; Morales, Daniel ; Ruiz, Carolina ; Navarrete, Pablo ; Vargas, Patricio ; Gálvez, Roberto ; Espinosa, Victoria ; Lazo, Marioli ; Pérez-Araos, Rodrigo A. ; Garay, Osvaldo ; Sepúlveda, Patrick ; Martinez, Edgardo ; Bruhn, Alejandro ; the SOCHIMI Prone-COVID-19 Group</creatorcontrib><description>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 PaO 2 :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, &gt; 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 PaO 2 :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.</description><identifier>ISSN: 2110-5820</identifier><identifier>EISSN: 2110-5820</identifier><identifier>DOI: 10.1186/s13613-022-01082-w</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Acute respiratory distress syndrome ; Anesthesiology ; Cohort analysis ; Coronavirus disease 2019 ; Coronaviruses ; COVID-19 ; Critical Care Medicine ; Emergency Medicine ; Injury prevention ; Intensive ; Intensive care ; Mechanical ventilation ; Medicine ; Medicine &amp; Public Health ; Mortality ; Patient positioning ; Pressure ulcers ; Prone positioning ; Severe acute respiratory syndrome coronavirus 2 ; Ventilation</subject><ispartof>Annals of intensive care, 2022-11, Vol.12 (1), p.109-109, Article 109</ispartof><rights>The Author(s) 2022</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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J.</creatorcontrib><creatorcontrib>Graf, Jerónimo</creatorcontrib><creatorcontrib>Alegría, Leyla</creatorcontrib><creatorcontrib>Baghetti, Romyna</creatorcontrib><creatorcontrib>Irarrázaval, Anita</creatorcontrib><creatorcontrib>Santis, César</creatorcontrib><creatorcontrib>Pavez, Nicolás</creatorcontrib><creatorcontrib>Leighton, Sofía</creatorcontrib><creatorcontrib>Tomicic, Vinko</creatorcontrib><creatorcontrib>Morales, Daniel</creatorcontrib><creatorcontrib>Ruiz, Carolina</creatorcontrib><creatorcontrib>Navarrete, Pablo</creatorcontrib><creatorcontrib>Vargas, Patricio</creatorcontrib><creatorcontrib>Gálvez, Roberto</creatorcontrib><creatorcontrib>Espinosa, Victoria</creatorcontrib><creatorcontrib>Lazo, Marioli</creatorcontrib><creatorcontrib>Pérez-Araos, Rodrigo A.</creatorcontrib><creatorcontrib>Garay, Osvaldo</creatorcontrib><creatorcontrib>Sepúlveda, Patrick</creatorcontrib><creatorcontrib>Martinez, Edgardo</creatorcontrib><creatorcontrib>Bruhn, Alejandro</creatorcontrib><creatorcontrib>the SOCHIMI Prone-COVID-19 Group</creatorcontrib><title>Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile</title><title>Annals of intensive care</title><addtitle>Ann. Intensive Care</addtitle><description>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 PaO 2 :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, &gt; 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 PaO 2 :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.</description><subject>Acute respiratory distress syndrome</subject><subject>Anesthesiology</subject><subject>Cohort analysis</subject><subject>Coronavirus disease 2019</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Injury prevention</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Mechanical ventilation</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Mortality</subject><subject>Patient positioning</subject><subject>Pressure ulcers</subject><subject>Prone positioning</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Ventilation</subject><issn>2110-5820</issn><issn>2110-5820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>COVID</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp9kktv3CAUha2qlRql-QNdIXXTjVvAYHAXlSKnj5EiReprizC-zDDCMAU7Uf59mXHUNl2UDVdwzqfL5VTVS4LfECLbt5k0LWlqTGmNCZa0vntSnVFCcM0lxU__qp9XFznvcVkcC0qbs8r2McwuLHHJ6JCij2EL47EKgA4xu9nF4MIWuYD6mx-bq5p0dQKv56K6_HL19R3SaFr87AyEGRIycRfTjPK8jPfIpjihfuc8vKieWe0zXDzs59X3jx--9Z_r65tPm_7yujZcsrkeQVCrKceDtkQ3rWTcNM1AOCcM-IAHzDSxRlhjOgtDg7Fm3Sg7ZlrDRtDNebVZuWPUe3VIbtLpXkXt1Okgpq3SqTTrQRFowQgBklFgTMqOguTSgJHMDKPtCuv9yjoswwTj8YFJ-0fQxzfB7dQ23qpOYCrbtgBePwBS_LlAntXksgHvdYAyb0UFwx3BrSRF-uof6T4uKZRRnVSCi46KoqKryqSYcwL7uxmC1TEKao2CKlFQpyiou2JqVlMu4vK76Q_6P65fHRm4Wg</recordid><startdate>20221128</startdate><enddate>20221128</enddate><creator>Cornejo, Rodrigo A.</creator><creator>Montoya, Jorge</creator><creator>Gajardo, Abraham I. 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J.</au><au>Graf, Jerónimo</au><au>Alegría, Leyla</au><au>Baghetti, Romyna</au><au>Irarrázaval, Anita</au><au>Santis, César</au><au>Pavez, Nicolás</au><au>Leighton, Sofía</au><au>Tomicic, Vinko</au><au>Morales, Daniel</au><au>Ruiz, Carolina</au><au>Navarrete, Pablo</au><au>Vargas, Patricio</au><au>Gálvez, Roberto</au><au>Espinosa, Victoria</au><au>Lazo, Marioli</au><au>Pérez-Araos, Rodrigo A.</au><au>Garay, Osvaldo</au><au>Sepúlveda, Patrick</au><au>Martinez, Edgardo</au><au>Bruhn, Alejandro</au><aucorp>the SOCHIMI Prone-COVID-19 Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile</atitle><jtitle>Annals of intensive care</jtitle><stitle>Ann. Intensive Care</stitle><date>2022-11-28</date><risdate>2022</risdate><volume>12</volume><issue>1</issue><spage>109</spage><epage>109</epage><pages>109-109</pages><artnum>109</artnum><issn>2110-5820</issn><eissn>2110-5820</eissn><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 PaO 2 :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, &gt; 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 PaO 2 :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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><doi>10.1186/s13613-022-01082-w</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0001-6691-7274</orcidid><orcidid>https://orcid.org/0000-0002-0930-4452</orcidid><orcidid>https://orcid.org/0000-0001-5292-9741</orcidid><orcidid>https://orcid.org/0000-0001-8034-1937</orcidid><orcidid>https://orcid.org/0000-0002-6387-3779</orcidid><orcidid>https://orcid.org/0000-0003-4470-9997</orcidid><orcidid>https://orcid.org/0000-0001-5657-7616</orcidid><orcidid>https://orcid.org/0000-0002-0497-5740</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 2110-5820
ispartof Annals of intensive care, 2022-11, Vol.12 (1), p.109-109, Article 109
issn 2110-5820
2110-5820
language eng
recordid cdi_doaj_primary_oai_doaj_org_article_1e6ec77e842e448892e858cec84cbdf9
source Access via ProQuest (Open Access); NCBI_PubMed Central(免费); Springer Nature - SpringerLink Journals - Fully Open Access; Coronavirus Research Database
subjects Acute respiratory distress syndrome
Anesthesiology
Cohort analysis
Coronavirus disease 2019
Coronaviruses
COVID-19
Critical Care Medicine
Emergency Medicine
Injury prevention
Intensive
Intensive care
Mechanical ventilation
Medicine
Medicine & Public Health
Mortality
Patient positioning
Pressure ulcers
Prone positioning
Severe acute respiratory syndrome coronavirus 2
Ventilation
title Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile
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