Duración de la primera maniobra de decúbito prono y su asociación con la mortalidad a 90 días en pacientes con insuficiencia respiratoria aguda por COVID-19: un estudio retrospectivo de terciles de tiempo

Objective

To investigate the association between the duration of the first prone positioning maneuver (PPM) and 90-day mortality in patients with C-ARDS.

Design

Retrospective, observational, and analytical study.

Setting

COVID-19 ICU of a tertiary hospital.

Patients

Adults over 18 years old, with a confirmed diagnosis of SARS-CoV-2 disease requiring PPM.

Interventions

Multivariable analysis of 90-day survival.

Main variables of interest

Duration of the first PPM, number of PPM sessions, 90-day mortality.

Results

271 patients undergoing PPM were analyzed: first tertile (n = 111), second tertile (n = 95) and third tertile (n = 65). The results indicated that the median duration of PDP was 14 hours (95% CI: 10-16 hours) in the first tertile, 19 hours (95% CI: 18-20 hours) in the second tertile and 22 hours (95% CI: 21-24 hours) in the third tertile. Comparison of survival curves using the Logrank test did not reach statistical significance (P = .11). Cox Regression analysis showed an association between the number of pronation sessions — patients receiving between 2 and 5 sessions (HR: 2.19; 95% CI: 1.07-4.49) and those receiving more than 5 sessions (HR: 6.05; 95% CI: 2.78-13.16 — and 90-day mortality.

Conclusions

While the duration of PDP does not appear to significantly influence 90-day mortality, the number of pronation sessions is identified as a significant factor associated with an increased risk of mortality.