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Available online 1 May 2024
Duration of the first prone positioning maneuver and its association with 90-day mortality in patients with acute respiratory failure due to COVID-19: A retrospective study of time terciles
Duración de la primera maniobra de decúbito prono y su asociación con la mortalidad a 90 días en pacientes con insuficiencia respiratoria aguda por COVID-19: un estudio retrospectivo de terciles de tiempo
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Alejandro González-Castroa,b, Carmen Huertas Martína, Elena Cuenca Fitoa, Yhivian Peñascoa, Camilo Gonzaleza, Juan Carlos Rodríguez Borregána,
Corresponding author
jrodriguez.borregan@scsalud.es

Corresponding author.
a Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
b Grupo Internacional de Ventilación Mecánica, WeVent
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Received 22 February 2024. Accepted 10 March 2024
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Table 1. Main variables of the study cohort.
Table 2. Comparison of the clinical-epidemiological characteristics of the patients according to time tertiles (hours) of the first PPM session.
Table 3. Comparative analysis between time tertiles (hours) of the first PPM session referred to the main variables associated with acute respiratory failure and therapeutic interventions in the ICU.
Table 4. Main evolutive variables analyzed between the different groups according to time tertile (hours) of the first PPM session.
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Abstract
Objective

To investigate the association between the duration of the first prone positioning maneuver (PPM) and 90-day mortality in patients with C-ARDS.

Design

Retrospective, observational, and analytical study.

Setting

COVID-19 ICU of a tertiary hospital.

Patients

Adults over 18 years old, with a confirmed diagnosis of SARS-CoV-2 disease requiring PPM.

Interventions

Multivariable analysis of 90-day survival.

Main variables of interest

Duration of the first PPM, number of PPM sessions, 90-day mortality.

Results

271 patients undergoing PPM were analyzed: first tertile (n = 111), second tertile (n = 95) and third tertile (n = 65). The results indicated that the median duration of PDP was 14 h (95% CI: 10−16 h) in the first tertile, 19 h (95% CI: 18−20 h) in the second tertile and 22 h (95% CI: 21−24 h) in the third tertile. Comparison of survival curves using the Logrank test did not reach statistical significance (p = 0.11). Cox Regression analysis showed an association between the number of pronation sessions (patients receiving between 2 and 5 sessions (HR = 2.19; 95% CI: 1.07–4.49); and those receiving more than 5 sessions (HR = 6.05; 95% CI: 2.78–13.16) and 90-day mortality.

Conclusions

while the duration of PDP does not appear to significantly influence 90-day mortality, the number of pronation sessions is identified as a significant factor associated with an increased risk of mortality.

Keywords:
Prone positioning
90-day mortality
C-ARDS
Resumen
Objetivo

investigar la asociación entre la duración de la primera maniobra de posición en decúbito prono (PDP) y la mortalidad a 90 días en pacientes con C-ARDS.

Diseño

estudio retrospectivo, observacional y analítico.

Ámbito

UCI-COVID de hospital terciario.

Pacientes

mayores de 18 años, con diagnóstico confirmado de enfermedad por de SARS-CoV-2 que necesitaron de maniobra de PDP.

Intervenciones

análisis multivariable de supervivencia a 90 días.

Variables de interés principales

duración de la primera PDP, número de sesiones de PDP, mortalidad a 90 días.

Resultados

271 pacientes sometidos a PDP fueron analizados: primer tercil (n = 111), segundo tercil (n = 95) y tercer tercil (n = 65). Los resultados indicaron que la mediana de la duración del PDP fue de 14 horas (IC95%: 10−16 horas) en el primer tercil, 19 horas (IC95%: 18−20 horas) en el segundo tercil y 22 horas (IC95%: 21−24 horas) en el tercer tercil. La comparación de las curvas de supervivencia a través de la prueba de Logrank, no alcanzó significancia estadística (p = 0,11). El análisis de Regresión de Cox evidenció asociación entre el número de sesiones de pronación (los pacientes que recibieron entre 2 y 5 sesiones (HR = 2,19; IC 95%: 1,07−4,49); y aquellos que recibieron más de 5 sesiones (HR = 6,05; IC 95%: 2,78−13,16) y la mortalidad a 90 días.

Conclusiones

mientras que la duración del PDP no parece influir de forma significativa en la mortalidad a 90 días, el número de sesiones de pronación se identifica como un factor significativo asociado con un mayor riesgo de mortalidad.

Palabras clave:
Decúbito prono
Mortalidad a 90 días
C-ARDS

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