TY - JOUR
T1 - Practice of Awake Prone Positioning in Critically Ill COVID-19 Patients—Insights from the PRoAcT–COVID Study
AU - Stilma, Willemke
AU - Valk, Christel M. A.
AU - van Meenen, David M. P.
AU - Morales, Luis
AU - Remmelzwaal, Daantje
AU - Myatra, Sheila N.
AU - Artigas, Antonio
AU - Neto, Ary Serpa
AU - Paulus, Frederique
AU - on behalf of the PRoAcT–COVID Collaborative Group
AU - Schultz, Marcus J.
AU - PRoAcT–COVID Collaborative Group
N1 - Funding Information: This research was funded by The Amsterdam UMC. Research time for WS was based on a personal grant from NWO Netherlands Organisation for Scientific Research (number 023.011.016), during the conduct of the study. Publisher Copyright: © 2022 by the authors.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - We describe the incidence, practice and associations with outcomes of awake prone positioning in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) in a national multicenter observational cohort study performed in 16 intensive care units in the Netherlands (PRoAcT–COVID-study). Patients were categorized in two groups, based on received treatment of awake prone positioning. The primary endpoint was practice of prone positioning. Secondary endpoint was ‘treatment failure’, a composite of intubation for invasive ventilation and death before day 28. We used propensity matching to control for observed confounding factors. In 546 patients, awake prone positioning was used in 88 (16.1%) patients. Prone positioning started within median 1 (0 to 2) days after ICU admission, sessions summed up to median 12.0 (8.4–14.5) hours for median 1.0 day. In the unmatched analysis (HR, 1.80 (1.41–2.31); p < 0.001), but not in the matched analysis (HR, 1.17 (0.87–1.59); p = 0.30), treatment failure occurred more often in patients that received prone positioning. The findings of this study are that awake prone positioning was used in one in six COVID-19 patients. Prone positioning started early, and sessions lasted long but were often discontinued because of need for intubation.
AB - We describe the incidence, practice and associations with outcomes of awake prone positioning in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) in a national multicenter observational cohort study performed in 16 intensive care units in the Netherlands (PRoAcT–COVID-study). Patients were categorized in two groups, based on received treatment of awake prone positioning. The primary endpoint was practice of prone positioning. Secondary endpoint was ‘treatment failure’, a composite of intubation for invasive ventilation and death before day 28. We used propensity matching to control for observed confounding factors. In 546 patients, awake prone positioning was used in 88 (16.1%) patients. Prone positioning started within median 1 (0 to 2) days after ICU admission, sessions summed up to median 12.0 (8.4–14.5) hours for median 1.0 day. In the unmatched analysis (HR, 1.80 (1.41–2.31); p < 0.001), but not in the matched analysis (HR, 1.17 (0.87–1.59); p = 0.30), treatment failure occurred more often in patients that received prone positioning. The findings of this study are that awake prone positioning was used in one in six COVID-19 patients. Prone positioning started early, and sessions lasted long but were often discontinued because of need for intubation.
KW - COVID-19
KW - acute hypoxemic respiratory failure
KW - awake prone positioning
KW - coronavirus disease 2019
KW - outcome
KW - prone positioning
KW - propensity matching
KW - self-proning
UR - http://www.scopus.com/inward/record.url?scp=85143705869&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/jcm11236988
DO - https://doi.org/10.3390/jcm11236988
M3 - Article
C2 - 36498564
SN - 2077-0383
VL - 11
JO - Journal of clinical medicine
JF - Journal of clinical medicine
IS - 23
M1 - 6988
ER -