Impact of prone position in non-intubated spontaneously breathing patients admitted to the ICU for severe acute respiratory failure due to COVID-19

• Published in: Journal of critical care 2021-08, Vol.64, p.199-204
• Main Authors: Jouffroy, Romain, Darmon, Michael, Isnard, Foucauld, Geri, Guillaume, Beurton, Alexandra, Fartoukh, Muriel, Tudesq, Jean-Jacques, Nemlaghi, Safaa, Demoule, Alexandre, Azoulay, Elie, Vieillard-Baron, Antoine
• Format: Article
• Language: English
• Subjects: Aged; Blood Gas Analysis; Cannula; Coronaviruses; COVID-19; COVID-19 - complications; Critical care; Emerging diseases; Female; Hemodynamics; High-flow nasal cannula; Human health and pathology; Humans; Hypertension; Infectious diseases; Intensive care; Intensive Care Units; Intubation; Kidney diseases; Laboratories; Life Sciences; Male; Mechanical ventilation; Middle Aged; Mortality; Paris; Paris - epidemiology; Patient Positioning; Patients; Prone Position; Propensity Score; Pulmonology and respiratory tract; Respiratory failure; Respiratory Insufficiency; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Retrospective Studies; Santé publique et épidémiologie; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Survival Analysis; Ventilators
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2021.04.014

Studies performed in spontaneously breathing patients with mild to moderate respiratory failure suggested that prone position (PP) in COVID-19 could be beneficial. Consecutive critically ill patients with COVID-19 were enrolled in four ICUs. PP sessions lasted at least 3 h each and were performed twice daily. A Cox proportional hazard model identified factors associated with the need of intubation. A propensity score overlap weighting analysis was performed to assess the association between spontaneous breathing PP (SBPP) and intubation. Among 379 patients, 40 underwent SBPP. Oxygenation was achieved by high flow nasal canula in all but three patients. Duration of proning was 2.5 [1.6;3.4] days. SBPP was well tolerated hemodynamically, increased PaO2/FiO2 (78 [68;96] versus 63 [53;77] mm Hg, p = 0.004) and PaCO2 (38 [34;43] versus 35 [32;38] mm Hg, p = 0.005). Neither day-28 survival (HR 0.51, 95% CI 0.16–1.16] nor risk of invasive ventilation [sHR 0.96; 95% CI 0.49;1.88] differed between patients who underwent PP and others. SBPP in COVID-19 is feasible and well tolerated in severely hypoxemic patients. It did not induce any effect on risk of intubation and day-28 mortality. •Our study reports that prone position performed in non-intubated spontaneously breathing patients with severe respiratory failure due to COVID-19 was performed in 10.5% of cases in a large cohort of 379 consecutive patients in 4 university centres.•This strategy was well-tolerated, significantly improved blood gas exchange and was not associated with the risk of intubation and mortality.