Prone Position in COVID-19 and -COVID-19 Acute Respiratory Distress Syndrome: An International Multicenter Observational Comparative Study*
| Autor: | Davide Chiumello, Claude Guérin, Pascal Beuret, Vincent Piriou, Nicolas Terzi, Thomas Rimmelé, Laurent Argaud, Luigi Camporota, Barnaby Sanderson, Martin Cour, Romain Metuor, Aude Verstraete, Julien Bohé |
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| Přispěvatelé: | CarMeN, laboratoire, Guy's and St Thomas' Hospital [London], King‘s College London, Università degli Studi di Milano = University of Milan (UNIMI), Université Grenoble Alpes (UGA), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Service de Médecine Intensive et Réanimation [Lyon] (MIR), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre Hospitalier de Roanne |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Respiratory Distress Syndrome/etiology/physiopathology/*therapy [SDV]Life Sciences [q-bio] medicine.medical_treatment Disease Critical Care and Intensive Care Medicine Patient Positioning Interquartile range Internal medicine Odds Ratio Prone Position medicine Humans Intubation Lung Artificial/*methods Aged Retrospective Studies Respiratory Distress Syndrome business.industry Respiration Lung/physiopathology COVID-19 Odds ratio Oxygenation Middle Aged Respiration Artificial Respiratory Function Tests [SDV] Life Sciences [q-bio] Europe Intensive Care Units Prone position COVID-19/complications/physiopathology/*therapy Female Observational study business Cohort study |
| Zdroj: | Critical Care Medicine Critical Care Medicine, 2022, 50 (4), pp.633-643. ⟨10.1097/ccm.0000000000005354⟩ |
| ISSN: | 0090-3493 1530-0293 |
| DOI: | 10.1097/ccm.0000000000005354 |
| Popis: | International audience; Objectives: Prone position is used in acute respiratory distress syndrome and in coronavirus disease 2019 acute respiratory distress syndrome. However, it is unclear how responders may be identified and whether an oxygenation response improves outcome. The objective of this study was to quantify the response to prone position, describe the differences between coronavirus disease 2019 acute respiratory distress syndrome and acute respiratory distress syndrome, and explore variables associated with survival.Design: Retrospective, observational, multicenter, international cohort study.Setting: Seven ICUs in Italy, United Kingdom, and France.Patients: Three hundred seventy-six adults (220 coronavirus disease 2019 acute respiratory distress syndrome and 156 acute respiratory distress syndrome).Intervention: None.Measurements and main results: Preproning, a greater proportion of coronavirus disease 2019 acute respiratory distress syndrome patients had severe disease (53% vs 40%), worse Pao2/Fio2 (13.0 kPa [interquartile range, 10.5-15.5 kPa] vs 14.1 kPa [interquartile range, 10.5-18.6 kPa]; p = 0.017) but greater compliance (38 mL/cm H2O [interquartile range, 27-53 mL/cm H2O] vs 31 mL/cm H2O [interquartile range, 21-37 mL/cm H2O]; p < 0.001). Patients with coronavirus disease 2019 acute respiratory distress syndrome had a longer median time from intubation to prone position (2.0 d [interquartile range, 0.7-5.0 d] vs 1.0 d [interquartile range, 0.5-2.9 d]; p = 0.03). The proportion of responders, defined by an increase in Pao2/Fio2 greater than or equal to 2.67 kPa (20 mm Hg), upon proning, was similar between acute respiratory distress syndrome and coronavirus disease 2019 acute respiratory distress syndrome (79% vs 76%; p = 0.5). Responders had earlier prone position (1.4 d [interquartile range, 0.7-4.2 d] vs 2.5 d [interquartile range, 0.8-6.2 d]; p = 0.06)]. Prone position less than 24 hours from intubation achieved greater improvement in oxygenation (11 kPa [interquartile range, 4-21 kPa] vs 7 kPa [interquartile range, 2-13 kPa]; p = 0.002). The variables independently associated with the "responder" category were Pao2/Fio2 preproning (odds ratio, 0.89 kPa-1 [95% CI, 0.85-0.93 kPa-1]; p < 0.001) and interval between intubation and proning (odds ratio, 0.94 d-1 [95% CI, 0.89-0.99 d-1]; p = 0.019). The overall mortality was 45%, with no significant difference observed between acute respiratory distress syndrome and coronavirus disease 2019 acute respiratory distress syndrome. Variables independently associated with mortality included age (odds ratio, 1.03 yr-1 [95% CI, 1.01-1.05 yr-1]; p < 0.001); interval between hospital admission and proning (odds ratio, 1.04 d-1 [95% CI, 1.002-1.084 d-1]; p = 0.047); and change in Pao2/Fio2 on proning (odds ratio, 0.97 kPa-1 [95% CI, 0.95-0.99 kPa-1]; p = 0.002).Conclusions: Prone position, particularly when delivered early, achieved a significant oxygenation response in ~80% of coronavirus disease 2019 acute respiratory distress syndrome, similar to acute respiratory distress syndrome. This response was independently associated with improved survival. |
| Databáze: | OpenAIRE |
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