Practice of Awake Prone Positioning in Critically Ill COVID-19 Patients—Insights from the PRoAcT–COVID Study
Issued Date
2022-12-01
Resource Type
eISSN
20770383
Scopus ID
2-s2.0-85143705869
Journal Title
Journal of Clinical Medicine
Volume
11
Issue
23
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Clinical Medicine Vol.11 No.23 (2022)
Suggested Citation
Stilma W., Valk C.M.A., van Meenen D.M.P., Morales L., Remmelzwaal D., Myatra S.N., Artigas A., Neto A.S., Paulus F., Schultz M.J. Practice of Awake Prone Positioning in Critically Ill COVID-19 Patients—Insights from the PRoAcT–COVID Study. Journal of Clinical Medicine Vol.11 No.23 (2022). doi:10.3390/jcm11236988 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85199
Title
Practice of Awake Prone Positioning in Critically Ill COVID-19 Patients—Insights from the PRoAcT–COVID Study
Author's Affiliation
Mahidol Oxford Tropical Medicine Research Unit
Hogeschool van Amsterdam, University of Applied Sciences
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
Universitat Autònoma de Barcelona
Monash University
Tata Memorial Hospital
Hospital Israelita Albert Einstein
Hospital Universitari de Bellvitge
Nuffield Department of Medicine
Amsterdam UMC - University of Amsterdam
Hogeschool van Amsterdam, University of Applied Sciences
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
Universitat Autònoma de Barcelona
Monash University
Tata Memorial Hospital
Hospital Israelita Albert Einstein
Hospital Universitari de Bellvitge
Nuffield Department of Medicine
Amsterdam UMC - University of Amsterdam
Other Contributor(s)
Abstract
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.
