Prolonged Prone Position Ventilation Is Associated With Reduced Mortality in Intubated COVID-19 Patients

Okin, Daniel; Huang, Ching‐Ying; Alba, George A.; Jesudasen, Sirus; Dandawate, Nupur; Gavralidis, Alexander; Chang, Leslie; Moin, Emily E.; Ahmad, Imama; Witkin, Alison S.; Hardin, C. Corey; Hibbert, Kathryn A.; Kadar, Aran; Gordan, Patrick L.; Lee, Hang; Thompson, B Taylor; Bebell, Lisa M.; Lai, Peggy S.

doi:10.1016/j.chest.2022.10.034

Cited by 29 publications

(34 citation statements)

References 34 publications

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“…This elegant article provides a signal regarding the possible advantages of prolonged PP in invasively ventilated patients with COVID-19 ARDS and integrates the value of time in mechanical ventilation during PP. Moreover, the findings by Okin et al 9 are perfectly aligned with data on spontaneously breathing patients with COVID-19, in which the cumulative time spent in awake PP has been shown to be associated directly to a survival benefit. 10 …”

supporting

confidence: 68%

“…However, although the findings by Okin et al 9 increase the knowledge in the field, they also leave some space for many additional questions. First, the precise mechanism associated with the time dependency of PP effect on mortality has not been explored and could be important for further understanding and advancement of the current state of art in lung protective ventilation.…”

mentioning

confidence: 99%

“…In this issue of CHEST , the concept of prolonged PP in COVID-19 ARDS was tested in the study by Okin et al. 9 The authors evaluated retrospectively whether prolongation of PP beyond the conventional 16 h may be associated with improved mortality. Interestingly, the authors found that intubated patients undergoing prolonged PP (with a median duration of the first session of 40 h) showed a lower mortality risk at 30 and 90 days as compared with patients undergoing an intermittent pronation strategy.…”

mentioning

confidence: 99%

“…Of note, time is a partially neglected element of the delicate relationship between lung injury and lung protection. The results of the study by Okin et al 9 seem to suggest that every time we interrupt PP, we are increasing the risk of ventilator-induced lung injury, and it is tempting to think that in those patients in whom we can reduce ventilator-induced lung injury by using PP, we are obtaining benefits. This is somehow expected when we decide to place patients in PP; what is new is that prolonged PP adds further benefits that we should take into account in our clinical practice.…”

mentioning

confidence: 99%

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Prone the Lung and Keep It Prone!

Spadaro¹,

Scaramuzzo²,

Volta³

2023

Chest

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supporting

confidence: 68%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Prone the Lung and Keep It Prone!

Spadaro¹,

Scaramuzzo²,

Volta³

2023

Chest

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“…In a recent retrospective study of intubated COVID-19 patients, Okin et al [18] reported reduced mortality and fewer pronation-supination cycles for the prolonged PP compared to the standard PP. The authors found no difference in oxygenation improvement between PPP and SPP, measured as the change of P/F ratio within 6 hours of pronation.…”

Section: Figure 1 P/f Ratio Change By Groupmentioning

confidence: 99%

Prone Position Ventilation in Severe ARDS Due to COVID-19: Comparison Between Prolonged and Intermittent Strategies

Karlis¹,

Markantonaki²,

Kakavas³

et al. 2023

Preprint

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Ventilation in prone position (PP) for 12 to 16 hours per day improves survival in ARDS. However, the optimal duration of the intervention is unknown. We performed a prospective observational study to compare the efficacy and safety of a prolonged PP protocol with conventional prone ventilation in COVID-19-associated ARDS. Prone position was undertaken if P/F <150 with FiO2>0.6 and PEEP>10cmH2O. Oxygenation parameters and respiratory mechanics were recorded before the first PP cycle, at the end of PP cycle and 4 hours after supination. We included 63 consecutive intubated patients with mean age 63.5 years. Of them, 37 (58.7%) underwent prolonged prone position (PPP group) and 26 (41.3%) standard prone position (SPP group). Median cycle duration for SPP group was 20 hrs and for PPP group 46 hrs (p<0.001). No significant differences in oxygenation, respiratory mechanics, number of PP cycles and rate of complications were observed between groups. The 28-day survival was 78.4% in the PPP group versus 65.4% in the SPP group (p=0.253). Extending the duration of PP was as safe and efficacious as conventional PP, but did not confer any survival benefit in a cohort of patients with severe ARDS due to COVID-19.

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