Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study

被引：51

作者：

Scaramuzzo, Gaetano ^{[1
,2
]}

Gamberini, Lorenzo ^{[3
]}

Tonetti, Tommaso ^{[4
]}

Zani, Gianluca ^{[5
]}

Ottaviani, Irene ^{[1
,2
]}

Mazzoli, Carlo Alberto ^{[3
]}

Capozzi, Chiara ^{[6
]}

Giampalma, Emanuela ^{[7
]}

Bacchi Reggiani, Maria Letizia ^{[8
]}

Bertellini, Elisabetta ^{[9
]}

Castelli, Andrea ^{[6
]}

Cavalli, Irene ^{[4
]}

Colombo, Davide ^{[10
,11
]}

Crimaldi, Federico ^{[12
]}

Damiani, Federica ^{[12
,13
]}

Fusari, Maurizio ^{[5
]}

Gamberini, Emiliano ^{[14
]}

Gordini, Giovanni ^{[2
,3
]}

Laici, Cristiana ^{[15
]}

Lanza, Maria Concetta ^{[16
]}

Leo, Mirco ^{[17
]}

Marudi, Andrea ^{[9
]}

Nardi, Giuseppe ^{[18
]}

Papa, Raffaella ^{[19
]}

Potalivo, Antonella ^{[18
]}

Russo, Emanuele ^{[14
]}

Taddei, Stefania ^{[20
]}

Consales, Guglielmo ^{[21
]}

Cappellini, Iacopo ^{[21
]}

Ranieri, Vito Marco ^{[4
]}

Volta, Carlo Alberto ^{[1
,2
]}

Guerin, Claude ^{[22
,23
]}

Spadaro, Savino ^{[1
,2
]}

机构：

[1] Univ Ferrara, Dept Translat Med & Romagna, Via Aldo Moro,8 Cona, I-44121 Ferrara, Italy

[2] Azienda Osped Univ, Via Aldo Moro,8 Cona, I-44121 Ferrara, Italy

[3] Osped Maggiore Carlo Alberto Pizzardi, Dept Anaesthesia, Intens Care & Prehosp Emergency, Bologna, Italy

[4] Univ Bologna, Policlin SantOrsola, Alma Mater Studiorum, Dipartimento Sci Med & Chirurg,Anesthesia & Inten, Bologna, Italy

[5] Santa Maria Croci Hosp, Dept Anesthesia & Intens Care, Ravenna, Italy

[6] Univ Bologna, S Orsola Hosp, Cardiothorac Vasc Dept, Cardioanesthesiol Unit, Bologna, Italy

[7] Osped Gen Provinciale M Bufalini, Dept Radiol, Cesena, Italy

[8] Alma Mater Univ, S Orsola Malpighi Hosp Bologna, Dept Clin Integrated & Expt Med DIMES, Stat Serv, Bologna, Italy

[9] Univ Hosp Modena, Dept Anaesthesiol, Via Pozzo 71, I-41100 Modena, Italy

[10] SS Trinita Hosp, Anaesthesia & Intens Care Dept, ASL, Novara, Italy

[11] Univ Piemonte Orientale, Translat Med Dept, Novara, Italy

[12] Eastern Piedmont Univ, Novara, Italy

[13] Imola Hosp, Dept Anaesthesia Intens Care & Pain Therapy, Imola, Italy

[14] Osped Gen Provinciale M Bufalini, Anaesthesia & Intens Care Unit, Cesena, Italy

[15] Azienda Osped Univ Bologna IRCCS, Dept Organ Failures & Transplants, Anesthesia & Intens Care Unit Transplant, Bologna, Italy

[16] GB Morgagni Pierantoni Hosp, Dept Anesthesia & Intens Care, Forli, Italy

[17] Azienda Osped SS Antonio E Biagio E Cesare, Dept Anaesthesia & Intens Care, Alessandria, Italy

[18] Infermi Hosp, Dept Anaesthesia & Intens Care, Rimini, Italy

[19] Santa Maria Annunziata Hosp, Anaesthesia & Intens Care Unit, Florence, Italy

[20] Bentivoglio Hosp, Anaesthesia & Intens Care Unit, Bologna, Italy

[21] Azienda USL Toscana Ctr, Dept Crit Care, Sect Anesthesiol & Intens Care, Prato, Italy

[22] Univ Lyon, Med Intens Reanimat Groupement, Hosp Edouard Herriot, Fac Med Lyon Est, Lyon, France

[23] Inst Mondor Rech Biomed, Creteil, France

来源：

ANNALS OF INTENSIVE CARE | 2021年 / 11卷 / 01期

关键词：

COVID19; Prone positioning; Ventilatory free days; ICU; RESPIRATORY-DISTRESS-SYNDROME; SURVIVAL;

D O I：

10.1186/s13613-021-00853-1

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background Prone positioning (PP) has been used to improve oxygenation in patients affected by the SARS-CoV-2 disease (COVID-19). Several mechanisms, including lung recruitment and better lung ventilation/perfusion matching, make a relevant rational for using PP. However, not all patients maintain the oxygenation improvement after returning to supine position. Nevertheless, no evidence exists that a sustained oxygenation response after PP is associated to outcome in mechanically ventilated COVID-19 patients. We analyzed data from 191 patients affected by COVID-19-related acute respiratory distress syndrome undergoing PP for clinical reasons. Clinical history, severity scores and respiratory mechanics were analyzed. Patients were classified as responders (>= median PaO2/FiO(2) variation) or non-responders (< median PaO2/FiO(2) variation) based on the PaO2/FiO(2) percentage change between pre-proning and 1 to 3 h after re-supination in the first prone positioning session. Differences among the groups in physiological variables, complication rates and outcome were evaluated. A competing risk regression analysis was conducted to evaluate if PaO2/FiO(2) response after the first pronation cycle was associated to liberation from mechanical ventilation. Results The median PaO2/FiO(2) variation after the first PP cycle was 49 [19-100%] and no differences were found in demographics, comorbidities, ventilatory treatment and PaO2/FiO(2) before PP between responders (96/191) and non-responders (95/191). Despite no differences in ICU length of stay, non-responders had a higher rate of tracheostomy (70.5% vs 47.9, P = 0.008) and mortality (53.7% vs 33.3%, P = 0.006), as compared to responders. Moreover, oxygenation response after the first PP was independently associated to liberation from mechanical ventilation at 28 days and was increasingly higher being higher the oxygenation response to PP. Conclusions Sustained oxygenation improvement after first PP session is independently associated to improved survival and reduced duration of mechanical ventilation in critically ill COVID-19 patients.

引用

页数：10

共 34 条

[1] Prone Position-induced Improvement in Gas Exchange Does Not Predict Improved Survival in the Acute Respiratory Distress Syndrome [J].