Timing of Prone Positioning During Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome
Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved..
OBJECTIVES: To assess the association of timing to prone positioning (PP) during venovenous extracorporeal membrane oxygenation (V-V ECMO) with the probability of being discharged alive from the ICU at 90 days (primary endpoint) and the improvement of the respiratory system compliance (Cpl,rs).
DESIGN: Pooled individual data analysis from five original observational cohort studies.
SETTING: European extracorporeal membrane oxygenation (ECMO) centers.
PATIENTS: Acute respiratory distress syndrome (ARDS) patients who underwent PP during ECMO.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Time to PP during V-V ECMO was explored both as a continuous and a categorical variable with Cox proportional hazard models. Three hundred patients were included in the analysis. The longer the time to PP during V-V ECMO, the lower the adjusted probability of alive ICU discharge (adjusted hazard ratio [HR] 0.90 for each day increase; 95% CI, 0.87-0.93). Two hundred twenty-three and 77 patients were included in the early PP (≤ 5 d) and late PP (> 5 d) groups, respectively. The cumulative 90-day probability of being discharged alive from the ICU was 61% in the early PP group vs 36% in the late PP group (log-rank test, p <0.001). This benefit was maintained after adjustment for confounders (adjusted HR, 2.52; 95% CI, 1.66-3.81; p <0.001). In the early PP group, PP was associated with a significant improvement of Cpl,rs (4 ± 9 mL/cm H2O vs 0 ± 12 in the late PP group, p=0.038).
CONCLUSIONS: In a large cohort of ARDS patients on ECMO, early PP during ECMO was associated with a higher probability of being discharged alive from the ICU at 90 days and a greater improvement of Cpl,rs.
| Errataetall: |
CommentIn: Crit Care Med. 2023 Jul 1;51(7):e148-e149. - PMID 37318299 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:51 |
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| Enthalten in: |
Critical care medicine - 51(2023), 1 vom: 01. Jan., Seite 25-35 |
| Sprache: |
Englisch |
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| Anmerkungen: |
Date Completed 19.12.2022 Date Revised 06.02.2024 published: Print-Electronic CommentIn: Crit Care Med. 2023 Jul 1;51(7):e148-e149. - PMID 37318299 Citation Status MEDLINE |
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| doi: |
10.1097/CCM.0000000000005705 |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Timing of Prone Positioning During Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome |
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| 500 | |a Date Completed 19.12.2022 | ||
| 500 | |a Date Revised 06.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Crit Care Med. 2023 Jul 1;51(7):e148-e149. - PMID 37318299 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. | ||
| 520 | |a OBJECTIVES: To assess the association of timing to prone positioning (PP) during venovenous extracorporeal membrane oxygenation (V-V ECMO) with the probability of being discharged alive from the ICU at 90 days (primary endpoint) and the improvement of the respiratory system compliance (Cpl,rs) | ||
| 520 | |a DESIGN: Pooled individual data analysis from five original observational cohort studies | ||
| 520 | |a SETTING: European extracorporeal membrane oxygenation (ECMO) centers | ||
| 520 | |a PATIENTS: Acute respiratory distress syndrome (ARDS) patients who underwent PP during ECMO | ||
| 520 | |a INTERVENTIONS: None | ||
| 520 | |a MEASUREMENTS AND MAIN RESULTS: Time to PP during V-V ECMO was explored both as a continuous and a categorical variable with Cox proportional hazard models. Three hundred patients were included in the analysis. The longer the time to PP during V-V ECMO, the lower the adjusted probability of alive ICU discharge (adjusted hazard ratio [HR] 0.90 for each day increase; 95% CI, 0.87-0.93). Two hundred twenty-three and 77 patients were included in the early PP (≤ 5 d) and late PP (> 5 d) groups, respectively. The cumulative 90-day probability of being discharged alive from the ICU was 61% in the early PP group vs 36% in the late PP group (log-rank test, p <0.001). This benefit was maintained after adjustment for confounders (adjusted HR, 2.52; 95% CI, 1.66-3.81; p <0.001). In the early PP group, PP was associated with a significant improvement of Cpl,rs (4 ± 9 mL/cm H2O vs 0 ± 12 in the late PP group, p=0.038) | ||
| 520 | |a CONCLUSIONS: In a large cohort of ARDS patients on ECMO, early PP during ECMO was associated with a higher probability of being discharged alive from the ICU at 90 days and a greater improvement of Cpl,rs | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Rezoagli, Emanuele |e verfasserin |4 aut | |
| 700 | 1 | |a Guervilly, Christophe |e verfasserin |4 aut | |
| 700 | 1 | |a Rilinger, Jonathan |e verfasserin |4 aut | |
| 700 | 1 | |a Duburcq, Thibault |e verfasserin |4 aut | |
| 700 | 1 | |a Petit, Matthieu |e verfasserin |4 aut | |
| 700 | 1 | |a Textoris, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Garcia, Bruno |e verfasserin |4 aut | |
| 700 | 1 | |a Wengenmayer, Tobias |e verfasserin |4 aut | |
| 700 | 1 | |a Bellani, Giacomo |e verfasserin |4 aut | |
| 700 | 1 | |a Grasselli, Giacomo |e verfasserin |4 aut | |
| 700 | 1 | |a Pesenti, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Combes, Alain |e verfasserin |4 aut | |
| 700 | 1 | |a Foti, Giuseppe |e verfasserin |4 aut | |
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| 700 | 0 | |a European Prone positioning During Extracorporeal Membrane Oxygenation (EuroPronECMO) Investigators |e verfasserin |4 aut | |
| 700 | 1 | |a Lucchini, Alberto |e investigator |4 oth | |
| 700 | 1 | |a Fumagalli, Benedetta |e investigator |4 oth | |
| 700 | 1 | |a Martucci, Gennaro |e investigator |4 oth | |
| 700 | 1 | |a Arcadipane, Antonio |e investigator |4 oth | |
| 700 | 1 | |a Garofalo, Eugenio |e investigator |4 oth | |
| 700 | 1 | |a Belliato, Mirko |e investigator |4 oth | |
| 700 | 1 | |a Fanelli, Vito |e investigator |4 oth | |
| 700 | 1 | |a Papazian, Laurent |e investigator |4 oth | |
| 700 | 1 | |a Forel, Jean-Marie |e investigator |4 oth | |
| 700 | 1 | |a Hraiech, Sami |e investigator |4 oth | |
| 700 | 1 | |a Roch, Antoine |e investigator |4 oth | |
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| 700 | 1 | |a Chommeloux, Juliette |e investigator |4 oth | |
| 700 | 1 | |a de Chambrun, Marc Pineton |e investigator |4 oth | |
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| 700 | 1 | |a Staudacher, Dawid L |e investigator |4 oth | |
| 700 | 1 | |a Supady, Alexander |e investigator |4 oth | |
| 700 | 1 | |a Biever, Paul |e investigator |4 oth | |
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