PT  - JOURNAL ARTICLE
AU  - Sáez de la Fuente, Ignacio
AU  - Marcos Morales, Adrián
AU  - Muñoz Calahorro, Reyes
AU  - Álvaro Valiente, Elena
AU  - Sánchez-Bayton Griffith, María
AU  - Chacón Alves, Silvia
AU  - Molina Collado, Zaira
AU  - González de Aledo, Amanda Lesmes
AU  - Martín Badía, Isaías
AU  - González Fernández, María
AU  - Orejón García, Lidia
AU  - Arribas López, Primitivo
AU  - Temprano Vázquez, Susana
AU  - Sánchez Izquierdo Riera, José Ángel
TI  - Optimal Prone Position Duration in Patients With ARDS Due to COVID-19: The Omelette Pilot Trial
AID  - 10.4187/respcare.11192
DP  - 2024 Mar 26
TA  - Respiratory Care
PG  - respcare.11192
4099  - http://rc.rcjournal.com/content/early/2024/03/26/respcare.11192.short
4100  - http://rc.rcjournal.com/content/early/2024/03/26/respcare.11192.full
AB  - 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.