RT Journal Article
SR Electronic
T1 Optimal Prone Position Duration in Patients With ARDS Due to COVID-19: The Omelette Pilot Trial
JF Respiratory Care
FD American Association for Respiratory Care
SP 806
OP 818
DO 10.4187/respcare.11192
VO 69
IS 7
A1 Sáez de la Fuente, Ignacio
A1 Marcos Morales, Adrián
A1 Muñoz Calahorro, Reyes
A1 Álvaro Valiente, Elena
A1 Sánchez-Bayton Griffith, María
A1 Chacón Alves, Silvia
A1 Molina Collado, Zaira
A1 González de Aledo, Amanda Lesmes
A1 Martín Badía, Isaías
A1 González Fernández, María
A1 Orejón García, Lidia
A1 Arribas López, Primitivo
A1 Temprano Vázquez, Susana
A1 Sánchez Izquierdo Riera, José Ángel
YR 2024
UL http://rc.rcjournal.com/content/69/7/806.abstract
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.