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Abstract
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.
Footnotes
- Correspondence: Ignacio Sáez de la Fuente MD, Department of Critical Care. Hospital Universitario 12 de Octubre. Avenida de Córdoba s/n, 28041, Madrid, Spain. E-mail: Ignacio.saez{at}salud.madrid.org
The authors have disclosed no conflicts of interest.
This paper was presented at ESICM LIVES 40, held May 12–14, 2022, in Madrid, Spain; at LVII National Congress of the Spanish Society of Intensive and Critical Medicine and Coronary Units, held June 12–15, 2022, in Seville, Spain; and at ESICM LIVES 2022 Annual Congress, held October 24–26, 2022, in Paris, France.
Supplementary material related to this paper is available at http://www.rcjournal.com.
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