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Prolonged Prone Position Ventilation Is Associated With Reduced Mortality in Intubated COVID-19 Patients

BACKGROUND: Prone position ventilation (PPV) is resource-intensive, yet the optimal strategy for PPV in intubated patients with COVID-19 is unclear. RESEARCH QUESTION: Does a prolonged (24 or more h) PPV strategy improve mortality in intubated COVID-19 patients compared with intermittent (∼16 h with...

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Autores principales: Okin, Daniel, Huang, Ching-Ying, Alba, George A., Jesudasen, Sirus J., Dandawate, Nupur A., Gavralidis, Alexander, Chang, Leslie L., Moin, Emily E., Ahmad, Imama, Witkin, Alison S., Hardin, C. Corey, Hibbert, Kathryn A., Kadar, Aran, Gordan, Patrick L., Lee, Hang, Thompson, B. Taylor, Bebell, Lisa M., Lai, Peggy S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American College of Chest Physicians 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9635255/
https://www.ncbi.nlm.nih.gov/pubmed/36343687
http://dx.doi.org/10.1016/j.chest.2022.10.034
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author Okin, Daniel
Huang, Ching-Ying
Alba, George A.
Jesudasen, Sirus J.
Dandawate, Nupur A.
Gavralidis, Alexander
Chang, Leslie L.
Moin, Emily E.
Ahmad, Imama
Witkin, Alison S.
Hardin, C. Corey
Hibbert, Kathryn A.
Kadar, Aran
Gordan, Patrick L.
Lee, Hang
Thompson, B. Taylor
Bebell, Lisa M.
Lai, Peggy S.
author_facet Okin, Daniel
Huang, Ching-Ying
Alba, George A.
Jesudasen, Sirus J.
Dandawate, Nupur A.
Gavralidis, Alexander
Chang, Leslie L.
Moin, Emily E.
Ahmad, Imama
Witkin, Alison S.
Hardin, C. Corey
Hibbert, Kathryn A.
Kadar, Aran
Gordan, Patrick L.
Lee, Hang
Thompson, B. Taylor
Bebell, Lisa M.
Lai, Peggy S.
author_sort Okin, Daniel
collection PubMed
description BACKGROUND: Prone position ventilation (PPV) is resource-intensive, yet the optimal strategy for PPV in intubated patients with COVID-19 is unclear. RESEARCH QUESTION: Does a prolonged (24 or more h) PPV strategy improve mortality in intubated COVID-19 patients compared with intermittent (∼16 h with daily supination) PPV? STUDY DESIGN AND METHODS: Multicenter, retrospective cohort study of consecutively admitted intubated COVID-19 patients treated with PPV between March 11 and May 31, 2020. The primary outcome was 30-day all-cause mortality. Secondary outcomes included 90-day all-cause mortality and prone-related complications. Inverse probability treatment weights (IPTW) were used to control for potential treatment selection bias. RESULTS: Of the COVID-19 patients who received PPV, 157 underwent prolonged and 110 underwent intermittent PPV. Patients undergoing prolonged PPV had reduced 30-day (adjusted hazard ratio [aHR], 0.475; 95% CI, 0.336-0.670; P < .001) and 90-day (aHR, 0.638; 95% CI, 0.461-0.883; P = .006) mortality compared with intermittent PPV. In patients with Pao(2)/Fio(2) ≤ 150 at the time of pronation, prolonged PPV was associated with reduced 30-day (aHR, 0.357; 95% CI, 0.213-0.597; P < .001) and 90-day mortality (aHR, 0.562; 95% CI, 0.357-0.884; P = .008). Patients treated with prolonged PPV underwent fewer pronation and supination events (median, 1; 95% CI, 1-2 vs 3; 95% CI, 1-4; P < .001). PPV strategy was not associated with overall PPV-related complications, although patients receiving prolonged PPV had increased rates of facial edema and lower rates of peri-proning hypotension. INTERPRETATION: Among intubated COVID-19 patients who received PPV, prolonged PPV was associated with reduced mortality. Prolonged PPV was associated with fewer pronation and supination events and a small increase in rates of facial edema. These findings suggest that prolonged PPV is a safe, effective strategy for mortality reduction in intubated COVID-19 patients.
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spelling pubmed-96352552022-11-04 Prolonged Prone Position Ventilation Is Associated With Reduced Mortality in Intubated COVID-19 Patients Okin, Daniel Huang, Ching-Ying Alba, George A. Jesudasen, Sirus J. Dandawate, Nupur A. Gavralidis, Alexander Chang, Leslie L. Moin, Emily E. Ahmad, Imama Witkin, Alison S. Hardin, C. Corey Hibbert, Kathryn A. Kadar, Aran Gordan, Patrick L. Lee, Hang Thompson, B. Taylor Bebell, Lisa M. Lai, Peggy S. Chest Critical Care: Original Research BACKGROUND: Prone position ventilation (PPV) is resource-intensive, yet the optimal strategy for PPV in intubated patients with COVID-19 is unclear. RESEARCH QUESTION: Does a prolonged (24 or more h) PPV strategy improve mortality in intubated COVID-19 patients compared with intermittent (∼16 h with daily supination) PPV? STUDY DESIGN AND METHODS: Multicenter, retrospective cohort study of consecutively admitted intubated COVID-19 patients treated with PPV between March 11 and May 31, 2020. The primary outcome was 30-day all-cause mortality. Secondary outcomes included 90-day all-cause mortality and prone-related complications. Inverse probability treatment weights (IPTW) were used to control for potential treatment selection bias. RESULTS: Of the COVID-19 patients who received PPV, 157 underwent prolonged and 110 underwent intermittent PPV. Patients undergoing prolonged PPV had reduced 30-day (adjusted hazard ratio [aHR], 0.475; 95% CI, 0.336-0.670; P < .001) and 90-day (aHR, 0.638; 95% CI, 0.461-0.883; P = .006) mortality compared with intermittent PPV. In patients with Pao(2)/Fio(2) ≤ 150 at the time of pronation, prolonged PPV was associated with reduced 30-day (aHR, 0.357; 95% CI, 0.213-0.597; P < .001) and 90-day mortality (aHR, 0.562; 95% CI, 0.357-0.884; P = .008). Patients treated with prolonged PPV underwent fewer pronation and supination events (median, 1; 95% CI, 1-2 vs 3; 95% CI, 1-4; P < .001). PPV strategy was not associated with overall PPV-related complications, although patients receiving prolonged PPV had increased rates of facial edema and lower rates of peri-proning hypotension. INTERPRETATION: Among intubated COVID-19 patients who received PPV, prolonged PPV was associated with reduced mortality. Prolonged PPV was associated with fewer pronation and supination events and a small increase in rates of facial edema. These findings suggest that prolonged PPV is a safe, effective strategy for mortality reduction in intubated COVID-19 patients. American College of Chest Physicians 2023-03 2022-11-04 /pmc/articles/PMC9635255/ /pubmed/36343687 http://dx.doi.org/10.1016/j.chest.2022.10.034 Text en © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
spellingShingle Critical Care: Original Research
Okin, Daniel
Huang, Ching-Ying
Alba, George A.
Jesudasen, Sirus J.
Dandawate, Nupur A.
Gavralidis, Alexander
Chang, Leslie L.
Moin, Emily E.
Ahmad, Imama
Witkin, Alison S.
Hardin, C. Corey
Hibbert, Kathryn A.
Kadar, Aran
Gordan, Patrick L.
Lee, Hang
Thompson, B. Taylor
Bebell, Lisa M.
Lai, Peggy S.
Prolonged Prone Position Ventilation Is Associated With Reduced Mortality in Intubated COVID-19 Patients
title Prolonged Prone Position Ventilation Is Associated With Reduced Mortality in Intubated COVID-19 Patients
title_full Prolonged Prone Position Ventilation Is Associated With Reduced Mortality in Intubated COVID-19 Patients
title_fullStr Prolonged Prone Position Ventilation Is Associated With Reduced Mortality in Intubated COVID-19 Patients
title_full_unstemmed Prolonged Prone Position Ventilation Is Associated With Reduced Mortality in Intubated COVID-19 Patients
title_short Prolonged Prone Position Ventilation Is Associated With Reduced Mortality in Intubated COVID-19 Patients
title_sort prolonged prone position ventilation is associated with reduced mortality in intubated covid-19 patients
topic Critical Care: Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9635255/
https://www.ncbi.nlm.nih.gov/pubmed/36343687
http://dx.doi.org/10.1016/j.chest.2022.10.034
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