Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients

Background Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. Methods Retrospecti...

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Published in:Critical care (London, England) Vol. 25; no. 1; pp. 128 - 11
Main Authors: Langer, Thomas, Brioni, Matteo, Guzzardella, Amedeo, Carlesso, Eleonora, Cabrini, Luca, Castelli, Gianpaolo, Dalla Corte, Francesca, De Robertis, Edoardo, Favarato, Martina, Forastieri, Andrea, Forlini, Clarissa, Girardis, Massimo, Grieco, Domenico Luca, Mirabella, Lucia, Noseda, Valentina, Previtali, Paola, Protti, Alessandro, Rona, Roberto, Tardini, Francesca, Tonetti, Tommaso, Zannoni, Fabio, Antonelli, Massimo, Foti, Giuseppe, Ranieri, Marco, Pesenti, Antonio, Fumagalli, Roberto, Grasselli, Giacomo
Format: Journal Article
Language:English
Published: London BioMed Central 06.04.2021
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Aged
Artificial respiration
Carbon dioxide
Care and treatment
Clinical outcomes
Cohort Studies
Coronaviruses
COVID-19
COVID-19 - therapy
Critical care
Critical Care - standards
Critical Care Medicine
Data collection
Emergency Medicine
Epidemics
Female
Gases
Hospital patients
Humans
Intensive
Intubation
Intubation - standards
Italy
Laboratories
Length of stay
Male
Mechanical ventilation
Medicine
Medicine & Public Health
Middle Aged
Patient outcomes
Patient positioning
Patient Positioning - standards
Patients
Positioning
Practice Guidelines as Topic
Prone Position
Prone positioning
Refractory hypoxemia
Respiration, Artificial - standards
Respiratory failure
Retrospective Studies
Severe acute respiratory syndrome coronavirus 2
Software
Supine Position
Trachea
Variance analysis
Ventilators
Italy
United Kingdom
COVID-19
Prone positioning
Refractory hypoxemia
Mechanical ventilation
ISSN:1364-8535, 1466-609X, 1364-8535, 1466-609X, 1366-609X
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Summary:Background Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. Methods Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO 2 /FiO 2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position. Results Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p  < 0.001). Overall, prone position induced a significant increase in PaO 2 /FiO 2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders . Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs . 38%, p  = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders . These patients were older and had more comorbidities; however, no difference in terms of ICU mortality was observed (51% vs . 37%, p  = 0.189 for Carbon Dioxide Responders and Non-Responders , respectively). Conclusions During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching. Trial registration : clinicaltrials.gov number: NCT04388670
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ISSN:1364-8535
1466-609X
1364-8535
1466-609X
1366-609X
DOI:10.1186/s13054-021-03552-2