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Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients.
Langer, Thomas; Brioni, Matteo; Guzzardella, Amedeo; Carlesso, Eleonora; Cabrini, Luca; Castelli, Gianpaolo; Dalla Corte, Francesca; De Robertis, Edoardo; Favarato, Martina; Forastieri, Andrea; Forlini, Clarissa; Girardis, Massimo; Grieco, Domenico Luca; Mirabella, Lucia; Noseda, Valentina; Previtali, Paola; Protti, Alessandro; Rona, Roberto; Tardini, Francesca; Tonetti, Tommaso; Zannoni, Fabio; Antonelli, Massimo; Foti, Giuseppe; Ranieri, Marco; Pesenti, Antonio; Fumagalli, Roberto; Grasselli, Giacomo.
  • Langer T; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
  • Brioni M; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy.
  • Guzzardella A; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
  • Carlesso E; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Cabrini L; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Castelli G; Ospedale di Circolo e Fondazione Macchi, Università degli studi dell'Insubria, Varese, Italy.
  • Dalla Corte F; Department of Anesthesiology and Intensive Care, ASST Mantova-Ospedale Carlo Poma, Mantova, Italy.
  • De Robertis E; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
  • Favarato M; Division of Anaesthesia, Analgesia and Intensive Care, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
  • Forastieri A; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
  • Forlini C; Department of Anesthesia and Intensive Care, A. Manzoni Hospital, ASST Lecco, Lecco, Italy.
  • Girardis M; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
  • Grieco DL; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy.
  • Mirabella L; Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy.
  • Noseda V; Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Previtali P; Sacred Heart Catholic University, Rome, Italy.
  • Protti A; Department of Medical and Surgical Sciences, Intensive Care Unit, University of Foggia, Foggia, Italy.
  • Rona R; Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
  • Tardini F; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy.
  • Tonetti T; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
  • Zannoni F; Department of Anaesthesia and Intensive Care, Humanitas Clinical and Research Center-IRCCS, Rozzano, MI, Italy.
  • Antonelli M; Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital ASST Monza, Monza, Italy.
  • Foti G; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy.
  • Ranieri M; Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy.
  • Pesenti A; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
  • Fumagalli R; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Grasselli G; Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Crit Care ; 25(1): 128, 2021 04 06.
Article in English | MEDLINE | ID: covidwho-1169981
ABSTRACT

BACKGROUND:

Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave.

METHODS:

Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO2/FiO2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position.

RESULTS:

Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p < 0.001). Overall, prone position induced a significant increase in PaO2/FiO2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders. Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs. 38%, p = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders. These patients were older and had more comorbidities; however, no difference in terms of ICU mortality was observed (51% vs. 37%, p = 0.189 for Carbon Dioxide Responders and Non-Responders, respectively).

CONCLUSIONS:

During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching. TRIAL REGISTRATION clinicaltrials.gov number NCT04388670.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Supine Position / Prone Position / Critical Care / Patient Positioning / COVID-19 / Intubation Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Crit Care Year: 2021 Document Type: Article Affiliation country: S13054-021-03552-2

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Supine Position / Prone Position / Critical Care / Patient Positioning / COVID-19 / Intubation Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Crit Care Year: 2021 Document Type: Article Affiliation country: S13054-021-03552-2