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Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes

The COVID-19 pandemic led to a broad implementation of proning to enhance oxygenation in both self-ventilating and mechanically ventilated critically ill patients with acute severe hypoxic respiratory failure. However, there is little data on the impact of the timing of the initiation of prone posit...

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Autores principales: Jackson, Alexander, Neyroud, Florence, Barnsley, Josephine, Hunter, Elsie, Beecham, Ryan, Radharetnas, Meiarasu, Grocott, Michael P. W., Dushianthan, Ahilanandan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342481/
https://www.ncbi.nlm.nih.gov/pubmed/37445260
http://dx.doi.org/10.3390/jcm12134226
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author Jackson, Alexander
Neyroud, Florence
Barnsley, Josephine
Hunter, Elsie
Beecham, Ryan
Radharetnas, Meiarasu
Grocott, Michael P. W.
Dushianthan, Ahilanandan
author_facet Jackson, Alexander
Neyroud, Florence
Barnsley, Josephine
Hunter, Elsie
Beecham, Ryan
Radharetnas, Meiarasu
Grocott, Michael P. W.
Dushianthan, Ahilanandan
author_sort Jackson, Alexander
collection PubMed
description The COVID-19 pandemic led to a broad implementation of proning to enhance oxygenation in both self-ventilating and mechanically ventilated critically ill patients with acute severe hypoxic respiratory failure. However, there is little data on the impact of the timing of the initiation of prone positioning in COVID-19 patients receiving mechanical ventilation. In this study, we analyzed our proning practices in mechanically ventilated COVID-19 patients. There were 931 total proning episodes in 144 patients, with a median duration of 16 h (IQR 15–17 h) per proning cycle. 563 proning cycles were initiated within 7 days of intubation (early), 235 within 7–14 days (intermediate), and 133 after 14 days (late). The mean change in oxygenation defined as the delta PaO(2)/FiO(2) ratio (ΔPF) after the prone episode was 16.6 ± 34.4 mmHg (p < 0.001). For early, intermediate, and late cycles, mean ΔPF ratios were 18.5 ± 36.7 mmHg, 13.2 ± 30.4 mmHg, and 14.8 ± 30.5 mmHg, with no significant difference in response between early, intermediate, and late proning (p = 0.2), respectively. Our findings indicate a favorable oxygenation response to proning episodes at all time points, even after >14 days of intubation. However, the findings cannot be translated directly into a survival advantage, and more research is needed in this area.
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spelling pubmed-103424812023-07-14 Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes Jackson, Alexander Neyroud, Florence Barnsley, Josephine Hunter, Elsie Beecham, Ryan Radharetnas, Meiarasu Grocott, Michael P. W. Dushianthan, Ahilanandan J Clin Med Article The COVID-19 pandemic led to a broad implementation of proning to enhance oxygenation in both self-ventilating and mechanically ventilated critically ill patients with acute severe hypoxic respiratory failure. However, there is little data on the impact of the timing of the initiation of prone positioning in COVID-19 patients receiving mechanical ventilation. In this study, we analyzed our proning practices in mechanically ventilated COVID-19 patients. There were 931 total proning episodes in 144 patients, with a median duration of 16 h (IQR 15–17 h) per proning cycle. 563 proning cycles were initiated within 7 days of intubation (early), 235 within 7–14 days (intermediate), and 133 after 14 days (late). The mean change in oxygenation defined as the delta PaO(2)/FiO(2) ratio (ΔPF) after the prone episode was 16.6 ± 34.4 mmHg (p < 0.001). For early, intermediate, and late cycles, mean ΔPF ratios were 18.5 ± 36.7 mmHg, 13.2 ± 30.4 mmHg, and 14.8 ± 30.5 mmHg, with no significant difference in response between early, intermediate, and late proning (p = 0.2), respectively. Our findings indicate a favorable oxygenation response to proning episodes at all time points, even after >14 days of intubation. However, the findings cannot be translated directly into a survival advantage, and more research is needed in this area. MDPI 2023-06-23 /pmc/articles/PMC10342481/ /pubmed/37445260 http://dx.doi.org/10.3390/jcm12134226 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Jackson, Alexander
Neyroud, Florence
Barnsley, Josephine
Hunter, Elsie
Beecham, Ryan
Radharetnas, Meiarasu
Grocott, Michael P. W.
Dushianthan, Ahilanandan
Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes
title Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes
title_full Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes
title_fullStr Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes
title_full_unstemmed Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes
title_short Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes
title_sort prone positioning in mechanically ventilated covid-19 patients: timing of initiation and outcomes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342481/
https://www.ncbi.nlm.nih.gov/pubmed/37445260
http://dx.doi.org/10.3390/jcm12134226
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