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Prone Positioning and Survival in Mechanically Ventilated Patients With Coronavirus Disease 2019-Related Respiratory

Kusum S Mathews1,2, Howard Soh1, Shahzad Shaefi3

  • 1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.

Critical Care Medicine
|February 17, 2021
PubMed

Insights

Early prone positioning in intensive care units (ICUs) significantly reduced mortality for patients with coronavirus disease 2019 (COVID-19) respiratory failure. This finding highlights the benefit of early intervention for severe COVID-19 cases.

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) poses a significant threat, causing respiratory failure in critically ill patients.
  • Prone positioning ventilation is a known therapy to improve survival in acute respiratory distress syndrome (ARDS).
  • Limited data exist on the survival benefits of early prone positioning specifically for COVID-19 patients.

Purpose of the Study:

  • To assess the impact of early prone positioning on mortality in mechanically ventilated COVID-19 patients with respiratory failure.
  • To quantify the effect of initiating prone positioning within two days of ICU admission on survival outcomes.

Main Methods:

  • A multicenter cohort study emulated a target trial using data from 2,338 critically ill COVID-19 patients across 68 U.S. hospitals.
  • Patients were categorized by early proning (within 2 days of ICU admission) versus no early proning.
  • An inverse probability-weighted Cox model was used to estimate the hazard ratio for mortality.

Main Results:

  • Among 2,338 patients, 702 (30.0%) received early prone positioning.
  • After weighting, baseline characteristics were balanced between groups.
  • Early prone positioning was associated with a reduced adjusted risk of death (hazard ratio, 0.84; 95% CI, 0.73-0.97).

Conclusions:

  • Early prone positioning in mechanically ventilated, hypoxemic COVID-19 patients is associated with lower in-hospital mortality.
  • This intervention offers a survival benefit for critically ill patients with COVID-19-associated respiratory failure.
Abstract

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