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

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dc.contributor.authorCornejo, Rodrigo
dc.contributor.authorMontoya, Jorge
dc.contributor.authorGajardo, Abraham
dc.contributor.authorGraf, Jerónimo
dc.contributor.authorAlegría, Leyla
dc.contributor.authorBaghetti, Romyna
dc.contributor.authorIrarrázaval, Anita
dc.contributor.authorSantis, César
dc.contributor.authorPavez, Nicolás
dc.contributor.authorLeighton, Sofía
dc.contributor.authorTomicic, Vinko
dc.contributor.authorMorales, Daniel
dc.contributor.authorRuiz, Carolina
dc.contributor.authorNavarrete, Pablo
dc.contributor.authorVargas, Patricio
dc.contributor.authorGálvez, Roberto
dc.contributor.authorEspinosa, Victoria
dc.contributor.authorLazo, Marioli
dc.contributor.authorPérez Araos, Rodrigo
dc.contributor.authorGaray, Osvaldo
dc.contributor.authorSepúlveda, Patrick
dc.contributor.authorMartínez, Edgardo
dc.contributor.authorBruhn, Alejandro
dc.contributor.authorSOCHIMI Prone-COVID-19 Group
dc.date.accessioned2023-12-15T13:13:46Z
dc.date.available2023-12-15T13:13:46Z
dc.date.issued2022
dc.description.abstractBackground: 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 PaO2:FiO2 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 PaO2:FiO2 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.
dc.description.versionVersión Publicada
dc.identifier.citationCornejo RA, Montoya J, Gajardo AIJ, Graf J, Alegría L, Baghetti R, Irarrázaval A, Santis C, Pavez N, Leighton S, Tomicic V, Morales D, Ruiz C, Navarrete P, Vargas P, Gálvez R, Espinosa V, Lazo M, Pérez-Araos RA, Garay O, Sepúlveda P, Martinez E, Bruhn A; SOCHIMI Prone-COVID-19 Group. Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile. Ann Intensive Care. 2022 Nov 28;12(1):109. doi: 10.1186/s13613-022-01082-w
dc.identifier.doihttps://doi.org/10.1186/s13613-022-01082-w
dc.identifier.urihttps://repositorio.udd.cl/handle/11447/8198
dc.language.isoen
dc.subjectAcute respiratory distress syndrome
dc.subjectCoronavirus disease 2019
dc.subjectMechanical ventilation
dc.subjectProne positioning
dc.titleContinuous prolonged prone positioning in COVID‑19‑related ARDS: a multicenter cohort study from Chile
dc.typeArticle
dcterms.accessRightsAcceso Abierto
dcterms.sourceAnnals of intensive care
dspace.entity.typePublication
relation.isAuthorOfPublication73f9a338-6885-4dcc-93c1-e6bacd44ccc7
relation.isAuthorOfPublicationd89dfad1-4573-42b7-95ba-267ca17be68f
relation.isAuthorOfPublication.latestForDiscovery73f9a338-6885-4dcc-93c1-e6bacd44ccc7

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