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Le Terrier, Christophe; Sigaud, Florian; Lebbah, Said; Desmedt, Luc; Hajage, David; Guérin, Claude; Pugin, Jérôme; Primmaz, Steve; Terzi, Nicolas; Mercat, Alain; Asfar, Pierre; Beloncle, François; Demiselle, Julien; Pham, Tài; Pavot, Arthur; Monnet, Xavier; Richard, Christian; Demoule, Alexandre; Dres, Martin; Mayaux, Julien; Beurton, Alexandra; Daubin, Cédric; Descamps, Richard; Joret, Aurélie; [...]

Early prone positioning in acute respiratory distress syndrome related to COVID-19: a propensity score analysis from the multicentric cohort COVID-ICU network—the ProneCOVID study

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  • Media type: E-Article
  • Title: Early prone positioning in acute respiratory distress syndrome related to COVID-19: a propensity score analysis from the multicentric cohort COVID-ICU network—the ProneCOVID study
  • Contributor: Le Terrier, Christophe; Sigaud, Florian; Lebbah, Said; Desmedt, Luc; Hajage, David; Guérin, Claude; Pugin, Jérôme; Primmaz, Steve; Terzi, Nicolas; Mercat, Alain; Asfar, Pierre; Beloncle, François; Demiselle, Julien; Pham, Tài; Pavot, Arthur; Monnet, Xavier; Richard, Christian; Demoule, Alexandre; Dres, Martin; Mayaux, Julien; Beurton, Alexandra; Daubin, Cédric; Descamps, Richard; Joret, Aurélie; [...]
  • imprint: Springer Science and Business Media LLC, 2022
  • Published in: Critical Care
  • Language: English
  • DOI: 10.1186/s13054-022-03949-7
  • ISSN: 1364-8535
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Delaying time to prone positioning (PP) may be associated with higher mortality in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). We evaluated the use and the impact of early PP on clinical outcomes in intubated patients hospitalized in intensive care units (ICUs) for COVID-19.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>All intubated patients with ARDS due to COVID-19 were involved in a secondary analysis from a prospective multicenter cohort study of COVID-ICU network including 149 ICUs across France, Belgium and Switzerland. Patients were followed-up until Day-90. The primary outcome was survival at Day-60. Analysis used a Cox proportional hazard model including a propensity score.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Among 2137 intubated patients, 1504 (70.4%) were placed in PP during their ICU stay and 491 (23%) during the first 24 h following ICU admission. One hundred and eighty-one patients (36.9%) of the early PP group had a PaO<jats:sub>2</jats:sub>/FiO<jats:sub>2</jats:sub> ratio &gt; 150 mmHg when prone positioning was initiated. Among non-early PP group patients, 1013 (47.4%) patients had finally been placed in PP within a median delay of 3 days after ICU admission. Day-60 mortality in non-early PP group was 34.2% versus 39.3% in the early PP group (<jats:italic>p</jats:italic> = 0.038). Day-28 and Day-90 mortality as well as the need for adjunctive therapies was more important in patients with early PP. After propensity score adjustment, no significant difference in survival at Day-60 was found between the two study groups (HR 1.34 [0.96–1.68], <jats:italic>p</jats:italic> = 0.09 and HR 1.19 [0.998–1.412], <jats:italic>p</jats:italic> = 0.053 in complete case analysis or in multiple imputation analysis, respectively). </jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In a large multicentric international cohort of intubated ICU patients with ARDS due to COVID-19, PP has been used frequently as a main treatment. In this study, our data failed to show a survival benefit associated with early PP started within 24 h after ICU admission compared to PP after day-1 for all COVID-19 patients requiring invasive mechanical ventilation regardless of their severity. </jats:p> </jats:sec>
  • Access State: Open Access