Extended Prone Position and 90-Day Mortality in Mechanically Ventilated Patients With COVID-19.

Area of Science:

• Critical Care Medicine
• Pulmonology
• Infectious Diseases

Background:

• Prone positioning (PP) improves outcomes in Acute Respiratory Distress Syndrome (ARDS) patients requiring mechanical ventilation.
• The efficacy of prolonged PP (>24 hours) in reducing mortality specifically for COVID-19 patients with ARDS remains uncertain.

Purpose of the Study:

• To evaluate the effect of extended prone positioning (EPP), defined as prone sessions ≥32 hours, on 90-day survival.
• To assess EPP's impact on COVID-19 patients with moderate-to-severe ARDS requiring mechanical ventilation.

Main Methods:

• Retrospective cohort study of 158 mechanically ventilated COVID-19 patients with moderate-to-severe ARDS.
• Comparison between standard PP (SPP) (n=76) and EPP (n=82).
• Statistical adjustments using cardinality matching (CM), matching weighting (MW), and stabilized/trimmed weights (SW) to minimize bias.

Main Results:

• Overall crude 90-day mortality was 31.7%.
• Unadjusted 90-day mortality was 19.5% in EPP vs. 44.7% in SPP (HR 0.35).
• Adjusted analyses (CM, MW, SW) consistently showed lower 90-day mortality in the EPP group (HRs ranging from 0.29 to 0.45).

Conclusions:

• Extended prone positioning (EPP) is associated with improved 90-day survival in mechanically ventilated COVID-19 patients with severe ARDS.
• EPP demonstrates potential benefits for managing COVID-19-related respiratory failure.
• Further prospective studies are needed to confirm these findings and explore underlying mechanisms.