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- Title
Optimal Prone Position Duration in Patients With ARDS Due to COVID-19: The Omelette Pilot Trial.
- Authors
Sáez de la Fuente, Ignacio; Marcos Morales, Adrián; Muñoz Calahorro, Reyes; Álvaro Valiente, Elena; Sánchez-Bayton Griffith, María; Chacón Alves, Silvia; Molina Collado, Zaira; González de Aledo, Amanda Lesmes; Martín Badía, Isaías; González Fernández, María; Orejón García, Lidia; Arribas López, Primitivo; Temprano Vázquez, Susana; Sánchez Izquierdo Riera, José Ángel
- 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.
- Subjects
SPAIN; ADULT respiratory distress syndrome treatment; SKELETAL muscle injuries; CONTINUING education units; BLOOD gases analysis; PEARSON correlation (Statistics); ADULT respiratory distress syndrome; DATA analysis; LYING down position; PILOT projects; STATISTICAL sampling; MULTIPLE regression analysis; FISHER exact test; TREATMENT duration; TREATMENT effectiveness; RANDOMIZED controlled trials; HOSPITALS; SEVERITY of illness index; HOSPITAL mortality; MANN Whitney U Test; CHI-squared test; MULTIVARIATE analysis; DESCRIPTIVE statistics; KAPLAN-Meier estimator; ARTIFICIAL respiration; INTENSIVE care units; RESPIRATORY organ physiology; STATISTICS; FRIEDMAN test (Statistics); CONFIDENCE intervals; EXTUBATION; LENGTH of stay in hospitals; AIRWAY (Anatomy); DATA analysis software; COVID-19; NEUROMUSCULAR blocking agents; ANESTHESIA; REGRESSION analysis; EVALUATION
- Publication
Respiratory Care, 2024, Vol 69, Issue 7, p806
- ISSN
0020-1324
- Publication type
Article
- DOI
10.4187/respcare.11192