Effect of the duration of prone position in ARDS patients during the SARS-CoV-2 pandemic.

OBJECTIVE: To describe the characteristics of patients with acute respiratory distress syndrome (ARDS) due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV), and to analyze the effect of prone position >24 h (prolonged) (PPP) compared to prone decubitus <24 h (PP). DESIGN: A retrospective observational descriptive study was carried out, with uni- and bivariate analyses. SETTING: Department of Intensive Care Medicine. Hospital General Universitario de Elche (Elche, Alicante, Spain). PARTICIPANTS: Patients with SARS-CoV-2 pneumonia (2020-2021) on IMV due to moderate-severe ARDS, ventilated in prone position (PP). INTERVENTIONS: IMV. PP maneuvers. MAIN VARIABLES OF INTEREST: Sociodemographic characteristics, analgo-sedation, neuromuscular blockade (NMB), PD duration, ICU stay and mortality, days of IMV, non-infectious complications, healthcare associated infections. RESULTS: Fifty-one patients required PP, and of these, 31 (69.78%) required PPP. No differences were observed in terms of patient characteristics (gender, age, comorbidities, initial severity, antiviral and antiinflammatory treatment received). Patients on PPP had poorer tolerance to supine ventilation (61.29% vs 89.47%, p = 0.031), longer hospital stay (41 vs 30 days, p = 0.023), more days of IMV (32 vs 20 days, p = 0.032), longer duration of NMB (10.5 vs 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39% vs 15%, p = 0.014). CONCLUSIONS: PPP was associated with greater resource use and complications in patients with moderate-severe ARDS due to COVID-19.

[Effect of duration of prone position in ARDS patients during SARS-CoV-2 pandemic]. / Efecto de la duración del decúbito prono en pacientes con SDRA durante la pandemia por SARS-CoV-2.

Objective: To describe the characteristics of patients with acute respiratory distress syndrome due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV) and analyze the effect of prolonged prone decubitus > 24 h (PPD) compared to prone decubitus < 24 h (PD). Design: Retrospective observational descriptive study. Uni and bivariate analysis. Setting: Department of Intensive Care Medicine. General University Hospital of Elche. Participants: Patients with SARS-CoV-2 pneumonia (2020-2021) in VMI for moderate-severe acute respiratory distress syndrome, ventilated in PD. Interventions: IMV. PD maneuvers. Main variables of interest: Sociodemographic; analgo-sedation; neuromuscular blockade; PD (duration), ICU stay and mortality, days of IMV; non-infectious complications; health care-associated infections. Results: Fifty-one patients required PD and of these 31 (69.78%) required PPD. No differences were found in patient characteristics (sex, age, comorbidities, initial severity, antiviral and anti-inflammatory treatment received). Patients on PPD had lower tolerance to supine ventilation (61.29 vs. 89.47%, p = 0.031), longer hospital stay (41 vs. 30 days, p = 0.023), more days of IMV (32 vs. 20 days, p = 0.032), longer duration of neuromuscular blockade (10.5 vs. 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39 vs. 15%, p = 0.014). Conclusions: PPD was associated with higher resource use and complications in patients with moderate-severe acute respiratory distress syndrome by COVID-19.

Effect of the duration of prone position in ards patients during the SARS-CoV-2 pandemic⋆ Efecto de la duración del decúbito prono en pacientes con sdra durante la pandemia por SARS-CoV-2

Graphical Objective To describe the characteristics of patients with acute respiratory distress syndrome (ARDS) due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV), and to analyze the effect of prone position >24 h (prolonged) (PPP) compared to prone decubitus <24 h (PP). Design A retrospective observational descriptive study was carried out, with uni- and bivariate analyses. Setting Department of Intensive Care Medicine. Hospital General Universitario de Elche (Elche, Alicante, Spain). Participants Patients with SARS-CoV-2 pneumonia (2020-2021) on IMV due to moderate-severe ARDS, ventilated in prone position (PP). Interventions IMV. PP maneuvers. Main variables of interest Sociodemographic characteristics, sedoanalgesia, neuromuscular blockade (NMB), PD duration, ICU stay and mortality, days of IMV, non-infectious complications, healthcare associated infections. Results Fifty-one patients required PP, and of these, 31 (69.78%) required PPP. No differences were observed in terms of patient characteristics (gender, age, comorbidities, initial severity, antiviral and antiinflammatory treatment received). Patients on PPP had poorer tolerance to supine ventilation (61.29% vs 89.47%, p = 0.031), longer hospital stay (41 vs 30 days, p = 0.023), more days of IMV (32 vs 20 days, p = 0.032), longer duration of NMB (10.5 vs 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39% vs 15%, p = 0.014). Conclusions PPP was associated with greater resource use and complications in patients with moderate-severe ARDS due to COVID-19.

[Effect of duration of prone position in ARDS patients during SARS-CoV-2 pandemic]. / Efecto de la duración del decúbito prono en pacientes con SDRA durante la pandemia por SARS-CoV-2.

Objective: To describe the characteristics of patients with acute respiratory distress syndrome due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV) and analyze the effect of prolonged prone decubitus > 24 h (PPD) compared to prone decubitus < 24 h (PD). Design: Retrospective observational descriptive study. Uni and bivariate analysis. Setting: Department of Intensive Care Medicine. General University Hospital of Elche. Participants: Patients with SARS-CoV-2 pneumonia (2020-2021) in VMI for moderate-severe acute respiratory distress syndrome, ventilated in PD. Interventions: IMV. PD maneuvers. Main variables of interest: Sociodemographic; analgo-sedation; neuromuscular blockade; PD (duration), ICU stay and mortality, days of IMV; non-infectious complications; health care-associated infections. Results: Fifty-one patients required PD and of these 31 (69.78%) required PPD. No differences were found in patient characteristics (sex, age, comorbidities, initial severity, antiviral and anti-inflammatory treatment received). Patients on PPD had lower tolerance to supine ventilation (61.29 vs. 89.47%, p = 0.031), longer hospital stay (41 vs. 30 days, p = 0.023), more days of IMV (32 vs. 20 days, p = 0.032), longer duration of neuromuscular blockade (10.5 vs. 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39 vs. 15%, p = 0.014). Conclusions: PPD was associated with higher resource use and complications in patients with moderate-severe acute respiratory distress syndrome by COVID-19.