by Christophe Le
Terrier, Thaïs Walter, Said Lebbah, David Hajage, Florian Sigaud, Claude
Guérin, Luc Desmedt, Steve Primmaz, Vincent Jousselin, Chiara Della Badia,
Jean-Damien Ricard, Jérôme Pugin and Nicolas Terzi
Annals of
Intensive Care volume 14, Article number: 100, Published: 27
June 2024
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.
