Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile

Area of Science:

• Critical Care Medicine
• Pulmonology
• Infectious Diseases

Background:

• Traditional prone positioning for acute respiratory distress syndrome (ARDS) involves limited daily sessions.
• Evidence on the feasibility and safety of prolonged prone positioning sessions is scarce.
• A nationwide continuous prolonged prone positioning strategy was implemented for COVID-19 patients in Chile.

Purpose of the Study:

• To analyze the feasibility and safety of a nationwide continuous prolonged prone positioning strategy.
• To evaluate the impact of prone session duration on patient outcomes and adverse events.

Main Methods:

• Retrospective cohort study of 417 mechanically ventilated COVID-19 patients with moderate-to-severe ARDS.
• Protocol: continuous prone sessions ≥48 hours until PaO2:FiO2 > 200 mmHg.
• Patients stratified into groups based on first prone session duration (2-3 days, 4-5 days, >5 days).
• Multivariable regression analyses to assess the impact of prone duration on safety.

Main Results:

• The first prone session duration was 4 days (3-5 days); 76.3% received only one session.
• Most common adverse event: grade 1-2 pressure sores (23.9%); severe events like non-scheduled extubations were infrequent (4.2%).
• 90-day mortality was 36.2%. Patients with >5 days of prone positioning had more severe ARDS and higher mortality (48%), but this was not linked to prone duration after adjustment.
• Prone session duration was not associated with increased mortality or pressure sores after adjusting for confounders.

Conclusions:

• Continuous prolonged prone positioning for COVID-19 ARDS is feasible nationwide.
• Minor pressure sores were common but within expected ranges; severe adverse events were rare.
• Prolonged prone positioning duration did not adversely affect patient safety or mortality.