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Vol. 48. Issue 3.
Pages 133-141 (March 2024)
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Vol. 48. Issue 3.
Pages 133-141 (March 2024)
Original article
Characteristics and risk factors associated with mortality during the first cycle of prone secondary to ARDS due to SARS-CoV-2 pneumonia
Características y factores de riesgo asociados a mortalidad durante el primer ciclo de prono por SDRA secundario a neumonía por SARS-CoV-2
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Cecilia Gonzaleza,
Corresponding author
ceciliagonzalez3383@gmail.com

Corresponding author.
, Gabriel Mussoa, Jesica Rodriguez Louzana, Juan Manuel Domingueza, Celeste Gomeza, Gabriel Appendinoa, Analía Abacaa, Lucio Clementea, Diana Latasaa, Martin Managoa, Carlos Lovesioa, Elisa Estenssorob
a Sanatorio Parque, Bv. Oroño 860, Rosario, Santa Fe, Argentina
b Hospital Interzonal de Agudos General San Martín de La Plata, Av. 1 1850, La Plata, Argentina
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Figures (2)
Tables (4)
Table 1. Baseline characteristics of patients receiving prone position for ARDS due to SARS-CoV-2.
Table 2. Oxygenation before and after the first prone position cycle. Comparison between survivors and non-survivors.
Table 3. Respiratory mechanics based on mortality and mechanical ventilation variables. Comparison between survivors and non-survivors.
Table 4. Cox regression, with mortality as an outcome variable.
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Abstract
Objective

To analyze characteristics, changes in oxygenation, and pulmonary mechanics, in mechanically ventilated patients with ARDS due to SARS-CoV-2 treated with prone position and evaluate the response to this maneuver.

Design

Cohort study including patients with PaO2/FiO2 <150mmHg requiring prone position over 18 months. We classified patients according to PaO2/FiO2 changes from basal to 24h after the first prone cycle as: 1) no increase 2) increase <25%, 3) 25%–50% increase 4) increase >50%.

Setting

33-bed medical-surgical Intensive Care Unit (ICU) in Argentina.

Patients

273 patients.

Interventions

None.

Main variables of interest

Epidemiological characteristics, respiratory mechanics and oxygenation were compared between survivors and non-survivors. Independent factors associated with in-hospital mortality were identified.

Results

Baseline PaO2/FiO2 was 116 [97–135]mmHg (115 [94–136] in survivors vs. 117 [98–134] in non-survivors; p=0.50). After prone positioning, 22 patients (8%) had similar PaO2/FiO2 values; 46(16%) increased PaO2/FiO2 ≤25%; 55 (21%) increased it 25%–50%; and 150 (55%), >50%. Mortality was 86%, 87%, 72% and 50% respectively (p<0.001). Baseline PaO2/FiO2, <100mmHg did not imply that patients were refractory to prone position. Factors independently associated with mortality were age, percentage increase in PaO2/FiO2 after 24h being in prone, and number of prone cycles.

Conclusions

Older patients unable to improve PaO2/FiO2 after 24h in prone position and who require >1 cycle might early receive additional treatments for refractory hypoxemia. After the first 24h in the prone position, a low percentage of PaO2/FiO2 increase over baseline, beyond the initial value, was independently associated with higher mortality.

Keywords:
ARDS
Decubitus prone
Prone position
COVID
SARS-CoV2
Prone failure
Refractory hypoxemia
ECMO
Resumen
Objetivo

Analizar las características, cambios en la oxigenación y mecánica pulmonar, en pacientes ventilados mecánicamente con SDRA por SARS-CoV-2 tratados con posición prona, y evaluar la respuesta a esta maniobra.

Diseño

Estudio de cohorte que incluyó pacientes con PaO2/FiO2 <150mmHg que requirieron posición prona durante 18 meses. Se clasificaron los pacientes según los cambios de PaO2/FiO2 desde el basal y 24horas después del primer ciclo prono como: 1) Sin aumento 2) Aumento <25%, 3) 25–50% de aumento 4) Aumento >50%.

Ambito

Unidad de Cuidados Intensivos (UCI) médico-quirúrgica de 33 camas en Argentina.

Pacientes

273 pacientes.

Intervenciones

Ninguna.

Principales variables de interés

Se compararon características epidemiológicas, mecánica respiratoria y oxigenación entre sobrevivientes y no sobrevivientes. Se identificaron factores independientes asociados a la mortalidad hospitalaria.

Resultados

La PaO2/FiO2 basal fue de 116 [97–135]mmHg (115 [94–136] en sobrevivientes vs. 117 [98–134] en no sobrevivientes; p=0,50). Después de la posición prona, 22 pacientes (8%) tenían valores similares de PaO2/FiO2; 46 (16%) aumentaron PaO2/FiO2 ≤25%; 55 (21%) lo aumentaron 25%–50%; y 150 (55%), >50%. La mortalidad fue de 86%, 87%, 72% y 50% respectivamente (p<0,001). La PaO2/FiO2 basal, <100mmHg no implicó que los pacientes fueran refractarios a la posición prona. Los factores asociados independientemente con la mortalidad fueron la edad, el aumento porcentual de PaO2/FiO2 después de 24horas en prona, y el número de ciclos prono.

Conclusiones

Los pacientes mayores que no pueden mejorar PaO2/FiO2 después de 24 horas en posición prona y que requieren más de 1 ciclo podrían recibir tratamientos adicionales para la hipoxemia refractaria. Después de las primeras 24horas en decúbito prono, un bajo porcentaje de aumento de PaO2/FiO2 sobre el valor basal, más allá del valor inicial, se asoció de forma independiente con una mayor mortalidad.

Palabras clave:
SDRA
Prono al decúbito
Posición prona
COVID
SARS-CoV2
Fallo prono
Hipoxemia refractaria
ECMO

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