期刊
CRITICAL CARE MEDICINE
卷 49, 期 7, 页码 1026-1037出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0000000000004938
关键词
adult; coronavirus disease 2019; intensive care units; prone position; respiratory distress syndrome; respiratory insufficiency
资金
- National Institute of Health (NIH)
- National Heart, Lung, and Blood Institute (NHLBI)
- NIH
- National Institute on Aging
- National Institute of General Medical Sciences
- RenalytixAI
- Relypsa
- Takeda Pharmaceuticals
- CHF Solutions
- Bayer
- Boehringer Ingelheim
- Akebia
- inRegen
- Renal Research Institute
- XORTX Therapeutics, Inc.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
- NIDDK
- Horizon Therapeutics PLC
- AstraZeneca
- Tate Latham
- CVS Caremark
- NHLBI
- BioPorto
- Gerson Lehrman Group
Early proning initiation is associated with lower mortality risk in hypoxemic patients with coronavirus disease 2019, compared to those who did not receive early proning.
OBJECTIVES: Therapies for patients with respiratory failure from coronavirus disease 2019 are urgently needed. Early implementation of prone positioning ventilation improves survival in patients with acute respiratory distress syndrome, but studies examining the effect of proning on survival in patients with coronavirus disease 2019 are lacking. Our objective was to estimate the effect of early proning initiation on survival in patients with coronavirus disease 2019-associated respiratory failure. DESIGN: Data were derived from the Study of the Treatment and Outcomes in Critically Ill Patients with coronavirus disease 2019, a multicenter cohort study of critically ill adults with coronavirus disease 2019 admitted to 68 U.S. hospitals. Using these data, we emulated a target trial of prone positioning ventilation by categorizing mechanically ventilated hypoxemic (ratio of Pao(2) over the corresponding Fio(2) <= 200 mm Hg) patients as having been initiated on proning or not within 2 days of ICU admission. We fit an inverse probability-weighted Cox model to estimate the mortality hazard ratio for early proning versus no early proning. Patients were followed until death, hospital discharge, or end of follow-up. SETTING: ICUs at 68 U.S. sites PATIENTS: Critically ill adults with laboratory-confirmed coronavirus disease 2019 receiving invasive mechanical ventilation with ratio of Pao(2) over the corresponding Fio(2) less than or equal to 200 mm Hg. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 2,338 eligible patients, 702 (30.0%) were proned within the first 2 days of ICU admission. After inverse probability weighting, baseline and severity of illness characteristics were well-balanced between groups. A total of 1,017 (43.5%) of the 2,338 patients were discharged alive, 1,101 (47.1%) died, and 220 (9.4%) were still hospitalized at last follow-up. Patients proned within the first 2 days of ICU admission had a lower adjusted risk of death compared with nonproned patients (hazard ratio, 0.84; 95% CI, 0.73-0.97). CONCLUSIONS: In-hospital mortality was lower in mechanically ventilated hypoxemic patients with coronavirus disease 2019 treated with early proning compared with patients whose treatment did not include early proning.
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