Prone Position Ventilation in Severe ARDS due to COVID-19: Comparison between Prolonged and Intermittent Strategies
Ventilation in a prone position (PP) for 12 to 16 h per day improves survival in ARDS. However, the optimal duration of the intervention is unknown. We performed a prospective observational study to compare the efficacy and safety of a prolonged PP protocol with conventional prone ventilation in COV...
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| Veröffentlicht in: | Journal of clinical medicine 2023-05, Vol.12 (10), p.3526 |
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| creator | Karlis, George Markantonaki, Despina Kakavas, Sotirios Bakali, Dimitra Katsagani, Georgia Katsarou, Theodora Kyritsis, Christos Karaouli, Vasiliki Athanasiou, Paraskevi Daganou, Mary |
| description | Ventilation in a prone position (PP) for 12 to 16 h per day improves survival in ARDS. However, the optimal duration of the intervention is unknown. We performed a prospective observational study to compare the efficacy and safety of a prolonged PP protocol with conventional prone ventilation in COVID-19-associated ARDS. Prone position was undertaken if P/F < 150 with FiO
> 0.6 and PEEP > 10 cm H
O. Oxygenation parameters and respiratory mechanics were recorded before the first PP cycle, at the end of the PP cycle and 4 h after supination. We included 63 consecutive intubated patients with a mean age of 63.5 years. Of them, 37 (58.7%) underwent prolonged prone position (PPP group) and 26 (41.3%) standard prone position (SPP group). The median cycle duration for the SPP group was 20 h and for the PPP group 46 h (
< 0.001). No significant differences in oxygenation, respiratory mechanics, number of PP cycles and rate of complications were observed between groups. The 28-day survival was 78.4% in the PPP group versus 65.4% in the SPP group (
= 0.253). Extending the duration of PP was as safe and efficacious as conventional PP, but did not confer any survival benefit in a cohort of patients with severe ARDS due to COVID-19. |
| doi_str_mv | 10.3390/jcm12103526 |
| format | Article |
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> 0.6 and PEEP > 10 cm H
O. Oxygenation parameters and respiratory mechanics were recorded before the first PP cycle, at the end of the PP cycle and 4 h after supination. We included 63 consecutive intubated patients with a mean age of 63.5 years. Of them, 37 (58.7%) underwent prolonged prone position (PPP group) and 26 (41.3%) standard prone position (SPP group). The median cycle duration for the SPP group was 20 h and for the PPP group 46 h (
< 0.001). No significant differences in oxygenation, respiratory mechanics, number of PP cycles and rate of complications were observed between groups. The 28-day survival was 78.4% in the PPP group versus 65.4% in the SPP group (
= 0.253). Extending the duration of PP was as safe and efficacious as conventional PP, but did not confer any survival benefit in a cohort of patients with severe ARDS due to COVID-19.</description><identifier>ISSN: 2077-0383</identifier><identifier>EISSN: 2077-0383</identifier><identifier>DOI: 10.3390/jcm12103526</identifier><identifier>PMID: 37240632</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Acute respiratory distress syndrome ; Airway management ; Anesthesia ; Artificial respiration ; Care and treatment ; Catheters ; Clinical medicine ; Coronaviruses ; COVID-19 ; Hemodynamics ; Hospitals ; Mechanics ; Methods ; Mortality ; Pandemics ; Patients ; Positioning ; Regression analysis ; Severe acute respiratory syndrome coronavirus 2 ; Variance analysis ; Ventilators</subject><ispartof>Journal of clinical medicine, 2023-05, Vol.12 (10), p.3526</ispartof><rights>COPYRIGHT 2023 MDPI AG</rights><rights>2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 by the authors. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-e97303ee2e2185ea5e11def522a5b9d44cc0581c6d3472ec1d8bbeb0a5c307e13</citedby><cites>FETCH-LOGICAL-c477t-e97303ee2e2185ea5e11def522a5b9d44cc0581c6d3472ec1d8bbeb0a5c307e13</cites><orcidid>0000-0003-0079-2477 ; 0009-0001-1726-5086 ; 0000-0003-1695-3511</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10218788/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10218788/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,882,27905,27906,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37240632$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karlis, George</creatorcontrib><creatorcontrib>Markantonaki, Despina</creatorcontrib><creatorcontrib>Kakavas, Sotirios</creatorcontrib><creatorcontrib>Bakali, Dimitra</creatorcontrib><creatorcontrib>Katsagani, Georgia</creatorcontrib><creatorcontrib>Katsarou, Theodora</creatorcontrib><creatorcontrib>Kyritsis, Christos</creatorcontrib><creatorcontrib>Karaouli, Vasiliki</creatorcontrib><creatorcontrib>Athanasiou, Paraskevi</creatorcontrib><creatorcontrib>Daganou, Mary</creatorcontrib><title>Prone Position Ventilation in Severe ARDS due to COVID-19: Comparison between Prolonged and Intermittent Strategies</title><title>Journal of clinical medicine</title><addtitle>J Clin Med</addtitle><description>Ventilation in a prone position (PP) for 12 to 16 h per day improves survival in ARDS. However, the optimal duration of the intervention is unknown. We performed a prospective observational study to compare the efficacy and safety of a prolonged PP protocol with conventional prone ventilation in COVID-19-associated ARDS. Prone position was undertaken if P/F < 150 with FiO
> 0.6 and PEEP > 10 cm H
O. Oxygenation parameters and respiratory mechanics were recorded before the first PP cycle, at the end of the PP cycle and 4 h after supination. We included 63 consecutive intubated patients with a mean age of 63.5 years. Of them, 37 (58.7%) underwent prolonged prone position (PPP group) and 26 (41.3%) standard prone position (SPP group). The median cycle duration for the SPP group was 20 h and for the PPP group 46 h (
< 0.001). No significant differences in oxygenation, respiratory mechanics, number of PP cycles and rate of complications were observed between groups. The 28-day survival was 78.4% in the PPP group versus 65.4% in the SPP group (
= 0.253). Extending the duration of PP was as safe and efficacious as conventional PP, but did not confer any survival benefit in a cohort of patients with severe ARDS due to COVID-19.</description><subject>Acute respiratory distress syndrome</subject><subject>Airway management</subject><subject>Anesthesia</subject><subject>Artificial respiration</subject><subject>Care and treatment</subject><subject>Catheters</subject><subject>Clinical medicine</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Hemodynamics</subject><subject>Hospitals</subject><subject>Mechanics</subject><subject>Methods</subject><subject>Mortality</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Positioning</subject><subject>Regression analysis</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Variance analysis</subject><subject>Ventilators</subject><issn>2077-0383</issn><issn>2077-0383</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNptkttrHCEUh6U0NGGbp74XoS-FMqmXcXX6UpZNLwuBhGybV3GcM1uXGd2ok9L_vqZJwyZEHzzod37Hc0HoDSUnnDfk49aOlFHCBZu_QEeMSFkRrvjLPfsQHae0JWUpVTMqX6FDLllN5pwdoXQRgwd8EZLLLnh8BT67wfyzncdruIEIeHF5usbdBDgHvDy_Wp1WtPmEl2HcmehSQVvIvwE8LmpD8BvosPEdXvkMcXQ5F1G8ztFk2DhIr9FBb4YEx_fnDP38-uXH8nt1dv5ttVycVbaWMlfQSE44AANGlQAjgNIOesGYEW3T1bW1RChq5x2vJQNLO9W20BIjLCcSKJ-hz3e6u6kdobPlF9EMehfdaOIfHYzTj1-8-6U34UZTUiJKpYrC-3uFGK4nSFmPLlkYBuMhTEkzxQhh9bw0YIbePUG3YYq-5Fco2tSilH-P2pgBtPN9KIHtraheSKE4F0KyQp08Q5Xdwehs6Vfvyv0jhw93DjaGlCL0D0lSom_nRO_NSaHf7tflgf0_Ffwvdzq3JA</recordid><startdate>20230517</startdate><enddate>20230517</enddate><creator>Karlis, George</creator><creator>Markantonaki, Despina</creator><creator>Kakavas, Sotirios</creator><creator>Bakali, Dimitra</creator><creator>Katsagani, Georgia</creator><creator>Katsarou, Theodora</creator><creator>Kyritsis, Christos</creator><creator>Karaouli, Vasiliki</creator><creator>Athanasiou, Paraskevi</creator><creator>Daganou, Mary</creator><general>MDPI AG</general><general>MDPI</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>COVID</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0079-2477</orcidid><orcidid>https://orcid.org/0009-0001-1726-5086</orcidid><orcidid>https://orcid.org/0000-0003-1695-3511</orcidid></search><sort><creationdate>20230517</creationdate><title>Prone Position Ventilation in Severe ARDS due to COVID-19: Comparison between Prolonged and Intermittent Strategies</title><author>Karlis, George ; 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However, the optimal duration of the intervention is unknown. We performed a prospective observational study to compare the efficacy and safety of a prolonged PP protocol with conventional prone ventilation in COVID-19-associated ARDS. Prone position was undertaken if P/F < 150 with FiO
> 0.6 and PEEP > 10 cm H
O. Oxygenation parameters and respiratory mechanics were recorded before the first PP cycle, at the end of the PP cycle and 4 h after supination. We included 63 consecutive intubated patients with a mean age of 63.5 years. Of them, 37 (58.7%) underwent prolonged prone position (PPP group) and 26 (41.3%) standard prone position (SPP group). The median cycle duration for the SPP group was 20 h and for the PPP group 46 h (
< 0.001). No significant differences in oxygenation, respiratory mechanics, number of PP cycles and rate of complications were observed between groups. The 28-day survival was 78.4% in the PPP group versus 65.4% in the SPP group (
= 0.253). Extending the duration of PP was as safe and efficacious as conventional PP, but did not confer any survival benefit in a cohort of patients with severe ARDS due to COVID-19.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>37240632</pmid><doi>10.3390/jcm12103526</doi><orcidid>https://orcid.org/0000-0003-0079-2477</orcidid><orcidid>https://orcid.org/0009-0001-1726-5086</orcidid><orcidid>https://orcid.org/0000-0003-1695-3511</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central Open Access; MDPI - Multidisciplinary Digital Publishing Institute; PubMed Central |
| subjects | Acute respiratory distress syndrome Airway management Anesthesia Artificial respiration Care and treatment Catheters Clinical medicine Coronaviruses COVID-19 Hemodynamics Hospitals Mechanics Methods Mortality Pandemics Patients Positioning Regression analysis Severe acute respiratory syndrome coronavirus 2 Variance analysis Ventilators |
| title | Prone Position Ventilation in Severe ARDS due to COVID-19: Comparison between Prolonged and Intermittent Strategies |
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