Optimal Prone Position Duration in Patients With ARDS Due to COVID-19 : The Omelette Pilot Trial
Copyright © 2024 by Daedalus Enterprises..
BACKGROUND: Prone position (PP) has been widely used in the COVID-19 pandemic for ARDS management. However, the optimal length of a PP session is still controversial. This study aimed to evaluate the effects of prolonged versus standard PP duration in subjects with ARDS due to COVID-19.
METHODS: This was a single-center, randomized controlled, parallel, and open pilot trial including adult subjects diagnosed with severe ARDS due to COVID-19 receiving invasive mechanical ventilation that met criteria for PP between March-September 2021. Subjects were randomized to the intervention group of prolonged PP (48 h) versus the standard of care PP (∼16 h). The primary outcome variable for the trial was ventilator-free days (VFDs) to day 28.
RESULTS: We enrolled 60 subjects. VFDs were not significantly different in the standard PP group (18 [interquartile range [IQR] 0-23] VFDs vs 7.5 [IQR 0-19.0] VFDs; difference, -10.5 (95% CI -3.5 to 19.0, P = .08). Prolonged PP was associated with longer time to successful extubation in survivors (13.00 [IQR 8.75-26.00] d vs 8.00 [IQR 5.00-10.25] d; difference, 5 [95% CI 0-15], P = .001). Prolonged PP was also significantly associated with longer ICU stay (18.5 [IQR 11.8-25.3] d vs 11.50 [IQR 7.75-25.00] d, P = .050) and extended administration of neuromuscular blockers (12.50 [IQR 5.75-20.00] d vs 5.0 [IQR 2.0-14.5] d, P = .005). Prolonged PP was associated with significant muscular impairment according to lower Medical Research Council values (59.6 [IQR 59.1-60.0] vs 56.5 [IQR 54.1-58.9], P = .02).
CONCLUSIONS: Among subjects with severe ARDS due to COVID-19, there was no difference in 28-d VFDs between prolonged and standard PP strategy. However, prolonged PP was associated with a longer ICU stay, increased use of neuromuscular blockers, and greater muscular impairment. This suggests that prolonged PP is not superior to the current recommended standard of care.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
|---|---|
| Enthalten in: |
Respiratory care - (2024) vom: 26. März |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Sáez de la Fuente, Ignacio [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
ARDS |
|---|
| Anmerkungen: |
Date Revised 26.03.2024 published: Print-Electronic Citation Status Publisher |
|---|
| doi: |
10.4187/respcare.11192 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM370211855 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM370211855 | ||
| 003 | DE-627 | ||
| 005 | 20240328000749.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240328s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.4187/respcare.11192 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1351.xml |
| 035 | |a (DE-627)NLM370211855 | ||
| 035 | |a (NLM)38531637 | ||
| 035 | |a (PII)respcare.11192 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Sáez de la Fuente, Ignacio |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Optimal Prone Position Duration in Patients With ARDS Due to COVID-19 |b The Omelette Pilot Trial |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 26.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2024 by Daedalus Enterprises. | ||
| 520 | |a BACKGROUND: Prone position (PP) has been widely used in the COVID-19 pandemic for ARDS management. However, the optimal length of a PP session is still controversial. This study aimed to evaluate the effects of prolonged versus standard PP duration in subjects with ARDS due to COVID-19 | ||
| 520 | |a METHODS: This was a single-center, randomized controlled, parallel, and open pilot trial including adult subjects diagnosed with severe ARDS due to COVID-19 receiving invasive mechanical ventilation that met criteria for PP between March-September 2021. Subjects were randomized to the intervention group of prolonged PP (48 h) versus the standard of care PP (∼16 h). The primary outcome variable for the trial was ventilator-free days (VFDs) to day 28 | ||
| 520 | |a RESULTS: We enrolled 60 subjects. VFDs were not significantly different in the standard PP group (18 [interquartile range [IQR] 0-23] VFDs vs 7.5 [IQR 0-19.0] VFDs; difference, -10.5 (95% CI -3.5 to 19.0, P = .08). Prolonged PP was associated with longer time to successful extubation in survivors (13.00 [IQR 8.75-26.00] d vs 8.00 [IQR 5.00-10.25] d; difference, 5 [95% CI 0-15], P = .001). Prolonged PP was also significantly associated with longer ICU stay (18.5 [IQR 11.8-25.3] d vs 11.50 [IQR 7.75-25.00] d, P = .050) and extended administration of neuromuscular blockers (12.50 [IQR 5.75-20.00] d vs 5.0 [IQR 2.0-14.5] d, P = .005). Prolonged PP was associated with significant muscular impairment according to lower Medical Research Council values (59.6 [IQR 59.1-60.0] vs 56.5 [IQR 54.1-58.9], P = .02) | ||
| 520 | |a CONCLUSIONS: Among subjects with severe ARDS due to COVID-19, there was no difference in 28-d VFDs between prolonged and standard PP strategy. However, prolonged PP was associated with a longer ICU stay, increased use of neuromuscular blockers, and greater muscular impairment. This suggests that prolonged PP is not superior to the current recommended standard of care | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ARDS | |
| 650 | 4 | |a ICU | |
| 650 | 4 | |a coronavirus disease 2019 | |
| 650 | 4 | |a mechanical ventilation | |
| 650 | 4 | |a prone position | |
| 650 | 4 | |a respiratory failure | |
| 700 | 1 | |a Marcos Morales, Adrián |e verfasserin |4 aut | |
| 700 | 1 | |a Muñoz Calahorro, Reyes |e verfasserin |4 aut | |
| 700 | 1 | |a Álvaro Valiente, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Sánchez-Bayton Griffith, María |e verfasserin |4 aut | |
| 700 | 1 | |a Chacón Alves, Silvia |e verfasserin |4 aut | |
| 700 | 1 | |a Molina Collado, Zaira |e verfasserin |4 aut | |
| 700 | 1 | |a González de Aledo, Amanda Lesmes |e verfasserin |4 aut | |
| 700 | 1 | |a Martín Badía, Isaías |e verfasserin |4 aut | |
| 700 | 1 | |a González Fernández, María |e verfasserin |4 aut | |
| 700 | 1 | |a Orejón García, Lidia |e verfasserin |4 aut | |
| 700 | 1 | |a Arribas López, Primitivo |e verfasserin |4 aut | |
| 700 | 1 | |a Temprano Vázquez, Susana |e verfasserin |4 aut | |
| 700 | 1 | |a Sánchez Izquierdo Riera, José Ángel |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Respiratory care |d 1974 |g (2024) vom: 26. März |w (DE-627)NLM07486520X |x 1943-3654 |7 nnns |
| 773 | 1 | 8 | |g year:2024 |g day:26 |g month:03 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.4187/respcare.11192 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |j 2024 |b 26 |c 03 | ||