Optimal Prone Position Duration in Patients With ARDS Due to COVID-19: The Omelette Pilot Trial.

Autor:	Sáez de la Fuente, Ignacio, Marcos Morales, Adrián, Muñoz Calahorro, Reyes, Álvaro Valiente, Elena, Sánchez-Bayton Griffith, María, Chacón Alves, Silvia, Molina Collado, Zaira, González de Aledo, Amanda Lesmes, Martín Badía, Isaías, González Fernández, María, Orejón García, Lidia, Arribas López, Primitivo, Temprano Vázquez, Susana, Sánchez Izquierdo Riera, José Ángel
Předmět:	ADULT respiratory distress syndrome treatment SKELETAL muscle injuries CONTINUING education units BLOOD gases analysis PEARSON correlation (Statistics) ADULT respiratory distress syndrome DATA analysis LYING down position PILOT projects STATISTICAL sampling MULTIPLE regression analysis FISHER exact test TREATMENT duration TREATMENT effectiveness RANDOMIZED controlled trials HOSPITALS SEVERITY of illness index HOSPITAL mortality MANN Whitney U Test CHI-squared test MULTIVARIATE analysis DESCRIPTIVE statistics KAPLAN-Meier estimator ARTIFICIAL respiration INTENSIVE care units RESPIRATORY organ physiology STATISTICS FRIEDMAN test (Statistics) CONFIDENCE intervals EXTUBATION LENGTH of stay in hospitals AIRWAY (Anatomy) DATA analysis software COVID-19 NEUROMUSCULAR blocking agents ANESTHESIA REGRESSION analysis EVALUATION
Zdroj:	Respiratory Care; Jul2024, Vol. 69 Issue 7, p806-818, 13p
Abstrakt:	Background: Prone position (PP) has been widely used in the COVID-19 pandemic for ARDS management. However, the optimal length of a PP session is still controversial. This study aimed to evaluate the effects of prolonged versus standard PP duration in subjects with ARDS due to COVID-19. Methods: This was a single-center, randomized controlled, parallel, and open pilot trial including adult subjects diagnosed with severe ARDS due to COVID-19 receiving invasive mechanical ventilation that met criteria for PP between March-September 2021. Subjects were randomized to the intervention group of prolonged PP (48 h) versus the standard of care PP (-16 h). The primary outcome variable for the trial was ventilator-free days (VFDs) to day 28. Results: We enrolled 60 subjects. VFDs were not significantly different in the standard PP group (18 [interquartile range [IQR] 0-23] VFDs vs 7.5 [IQR 0-19.0] VFDs; difference, -10.5 (95% CI -3.5 to 19.0, P = .08). Prolonged PP was associated with longer time to successful extubation in survivors (13.00 [IQR 8.75-26.00] d vs 8.00 [IQR 5.00-10.25] d; difference, 5 [95% CI 0-15], P = .001). Prolonged PP was also significantly associated with longer ICU stay (18.5 [IQR 11.8-25.3] d vs 11.50 [IQR 7.75-25.00] d, P = .050) and extended administration of neuromuscular blockers (12.50 [IQR 5.75-20.00] d vs 5.0 [IQR 2.0-14.5] d, P = .005). Prolonged PP was associated with significant muscular impairment according to lower Medical Research Council values (59.6 [IQR 59.1-60.0] vs 56.5 [IQR 54.1-58.9], P = .02). Conclusions: Among subjects with severe ARDS due to COVID-19, there was no difference in 28-d VFDs between prolonged and standard PP strategy. However, prolonged PP was associated with a longer ICU stay, increased use of neuromuscular blockers, and greater muscular impairment. This suggests that prolonged PP is not superior to the current recommended standard of care. [ABSTRACT FROM AUTHOR]
Databáze:	Supplemental Index
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