Impact of intensive prone position therapy on outcomes in intubated patients with ARDS related to COVID-19.

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE Annals of Intensive Care Pub Date : 2024-06-27 DOI:10.1186/s13613-024-01340-z
Christophe Le Terrier, Thaïs Walter, Said Lebbah, David Hajage, Florian Sigaud, Claude Guérin, Luc Desmedt, Steve Primmaz, Vincent Joussellin, Chiara Della Badia, Jean-Damien Ricard, Jérôme Pugin, Nicolas Terzi
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Abstract

Background: Previous retrospective research has shown that maintaining prone positioning (PP) for an average of 40 h is associated with an increase of survival rates in intubated patients with COVID-19-related acute respiratory distress syndrome (ARDS). This study aims to determine whether a cumulative PP duration of more than 32 h during the first 2 days of intensive care unit (ICU) admission is associated with increased survival compared to a cumulative PP duration of 32 h or less.

Methods: This study is an ancillary analysis from a previous large international observational study involving intubated patients placed in PP in the first 48 h of ICU admission in 149 ICUs across France, Belgium and Switzerland. Given that PP is recommended for a 16-h daily duration, intensive PP was defined as a cumulated duration of more than 32 h during the first 48 h, whereas standard PP was defined as a duration equal to or less than 32 h. Patients were followed-up for 90 days. The primary outcome was mortality at day 60. An Inverse Probability Censoring Weighting (IPCW) Cox model including a target emulation trial method was used to analyze the data.

Results: Out of 2137 intubated patients, 753 were placed in PP during the first 48 h of ICU admission. The intensive PP group (n = 79) had a median PP duration of 36 h, while standard PP group (n = 674) had a median of 16 h during the first 48 h. Sixty-day mortality rate in the intensive PP group was 39.2% compared to 38.7% in the standard PP group (p = 0.93). Twenty-eight-day and 90-day mortality as well as the ventilator-free days until day 28 were similar in both groups. After IPCW, there was no significant difference in mortality at day 60 between the two-study groups (HR 0.95 [0.52-1.74], p = 0.87 and HR 1.1 [0.77-1.57], p = 0.61 in complete case analysis or in multiple imputation analysis, respectively).

Conclusions: This secondary analysis of a large multicenter European cohort of intubated patients with ARDS due to COVID-19 found that intensive PP during the first 48 h did not provide a survival benefit compared to standard PP.

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COVID-19相关的强化俯卧位疗法对ARDS插管患者预后的影响。
背景:以往的回顾性研究表明,在插管的 COVID-19 相关急性呼吸窘迫综合征(ARDS)患者中,保持俯卧位(PP)平均 40 小时与存活率的提高有关。本研究旨在确定,与累计 32 小时或更短的 PP 持续时间相比,在入住重症监护病房(ICU)的头 2 天内,累计 PP 持续时间超过 32 小时是否与存活率的提高有关:本研究是之前一项大型国际观察性研究的辅助分析,该研究涉及法国、比利时和瑞士 149 家重症监护病房中在入院后 48 小时内插管的患者。鉴于PP的推荐持续时间为每天16小时,因此强化PP被定义为在最初48小时内累计持续时间超过32小时,而标准PP被定义为持续时间等于或少于32小时。主要结果是第 60 天的死亡率。数据分析采用了包括目标模拟试验法在内的逆概率加权(IPCW)Cox模型:在 2137 名插管患者中,有 753 人在入住重症监护室的前 48 小时内被置于 PP 组。强化PP组(79人)的PP持续时间中位数为36小时,而标准PP组(674人)的PP持续时间中位数为16小时(P=0.93)。两组的 28 天和 90 天死亡率以及第 28 天前无呼吸机天数相似。IPCW后,两组患者在第60天的死亡率无显著差异(在完整病例分析或多重归因分析中分别为HR 0.95 [0.52-1.74],p = 0.87和HR 1.1 [0.77-1.57],p = 0.61):这项对欧洲大型多中心队列中因COVID-19导致ARDS的插管患者进行的二次分析发现,与标准PP相比,在最初48小时内进行强化PP并不能提高患者的生存率。
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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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