Oxygenation improvement and duration of prone positioning are associated with ICU mortality in mechanically ventilated COVID-19 patients
Abstract Background Prone position has been diffusely applied in mechanically ventilated COVID-19 patients. Our aim is ascertaining the association between the physiologic response and the length of the first cycle of prone position and intensive care unit (ICU) mortality. Methods International regi...
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2025-01-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-025-01438-y |
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| author | Silvia De Rosa Nicolò Sella Giacomo Bellani Giuseppe Foti Andrea Cortegiani Giulia Lorenzoni Dario Gregori Annalisa Boscolo Lucia Cattin Muhammed Elhadi Giorgio Fullin Eugenio Garofalo Leonardo Gottin Alberto Grassetto Salvatore Maurizio Maggiore Elena Momesso Mario Peta Daniele Poole Roberto Rona Ivo Tiberio Andrea Zanoletti Emanuele Rezoagli Paolo Navalesi for the SIAARTI Study Group |
| author_facet | Silvia De Rosa Nicolò Sella Giacomo Bellani Giuseppe Foti Andrea Cortegiani Giulia Lorenzoni Dario Gregori Annalisa Boscolo Lucia Cattin Muhammed Elhadi Giorgio Fullin Eugenio Garofalo Leonardo Gottin Alberto Grassetto Salvatore Maurizio Maggiore Elena Momesso Mario Peta Daniele Poole Roberto Rona Ivo Tiberio Andrea Zanoletti Emanuele Rezoagli Paolo Navalesi for the SIAARTI Study Group |
| author_sort | Silvia De Rosa |
| collection | DOAJ |
| description | Abstract Background Prone position has been diffusely applied in mechanically ventilated COVID-19 patients. Our aim is ascertaining the association between the physiologic response and the length of the first cycle of prone position and intensive care unit (ICU) mortality. Methods International registry including COVID-19 adult patients who underwent prone positioning. We measured the difference for arterial partial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2), ventilatory ratio, and respiratory system compliance (Crs) between baseline supine position and at either the end of the first cycle of prone position (Delta-PP) or re-supination (Delta-PostPP). Results We enrolled 1816 patients from 53 centers. Delta-PP and Delta-PostPP for PaO2/FiO2 were both associated with ICU mortality [OR (95% CI) 0.48 (0.38, 0.59), and OR (95% CI) 0.60 (0.52, 0.68), respectively]. Ventilatory ratio had a non-linear relationship with ICU mortality for Delta-PP (p = 0.022) and Delta-PostPP (p = 0.004). Delta-PP, while not Delta-PostPP, for Crs was associated with ICU mortality [OR (95% CI) 0.80 (0.65, 0.98)]. The length of the first cycle of prone position showed an inverse relationship with ICU mortality [OR (95% CI) 0.82 (0.73, 0.91)]. At the multivariable analysis, the duration of the first cycle of prone position, Delta-PP and Delta-PostPP for PaO2/FiO2, and Delta-PostPP for ventilatory ratio were independently associated with ICU mortality. Conclusion In COVID-19 patients with acute respiratory failure receiving invasive mechanical ventilation and prone positioning, the physiological response to prone position is associated with ICU mortality. Prolonging the duration of the first cycle of prone position is associated with improved survival. |
| format | Article |
| id | doaj-art-cc18d9329dd942ef955ee0023727d5a6 |
| institution | Kabale University |
| issn | 2110-5820 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SpringerOpen |
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| series | Annals of Intensive Care |
| spelling | doaj-art-cc18d9329dd942ef955ee0023727d5a62025-02-02T12:42:26ZengSpringerOpenAnnals of Intensive Care2110-58202025-01-0115111510.1186/s13613-025-01438-yOxygenation improvement and duration of prone positioning are associated with ICU mortality in mechanically ventilated COVID-19 patientsSilvia De Rosa0Nicolò Sella1Giacomo Bellani2Giuseppe Foti3Andrea Cortegiani4Giulia Lorenzoni5Dario Gregori6Annalisa Boscolo7Lucia Cattin8Muhammed Elhadi9Giorgio Fullin10Eugenio Garofalo11Leonardo Gottin12Alberto Grassetto13Salvatore Maurizio Maggiore14Elena Momesso15Mario Peta16Daniele Poole17Roberto Rona18Ivo Tiberio19Andrea Zanoletti20Emanuele Rezoagli21Paolo Navalesi22for the SIAARTI Study GroupCentre for Medical Sciences-CISMed, University of TrentoInstitute of Anesthesia and Intensive Care, Padova University HospitalCentre for Medical Sciences-CISMed, University of TrentoDepartment of Medicine and Surgery, University of Milano-Bicocca, San Gerardo HospitalDepartment of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of PalermoUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of PadovaUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of PadovaInstitute of Anesthesia and Intensive Care, Padova University HospitalUOC Anestesia e Rianimazione, AULSS8 Berica, Ospedale San BortoloFaculty of Medicine, University of TripoliAnesthesia and Intensive CareAnaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia UniversityDipartimento di Emergenza e Terapie Intensive, UOC di Anestesia e Terapia Intensiva Cardio-Toraco-Vascolare, Azienda Ospedaliera Universitaria Integrata di VeronaUOC Anestesia E RianimazioneUniversity Department of Innovative Technologies in Medicine and Dentistry, Gabriele d’Annunzio University of Chieti-PescaraAnaesthesia and Intensive Care Unit, Ospedali di San Donà di Piave e JesoloDepartment of Anesthesia and Intensive Care, Santa Maria dei Battuti-Ca’ Foncello HospitalAnesthesia and Critical Care Unit, Ospedale di BellunoDepartment of Medicine and Surgery, University of Milano-Bicocca, San Gerardo HospitalUOC Anestesia e Rianimazione, Padova University HospitalAnesthesia and Intensive Care Unit, Manerbio HospitalDepartment of Medicine and Surgery, University of Milano-Bicocca, San Gerardo HospitalInstitute of Anesthesia and Intensive Care, Padova University HospitalAbstract Background Prone position has been diffusely applied in mechanically ventilated COVID-19 patients. Our aim is ascertaining the association between the physiologic response and the length of the first cycle of prone position and intensive care unit (ICU) mortality. Methods International registry including COVID-19 adult patients who underwent prone positioning. We measured the difference for arterial partial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2), ventilatory ratio, and respiratory system compliance (Crs) between baseline supine position and at either the end of the first cycle of prone position (Delta-PP) or re-supination (Delta-PostPP). Results We enrolled 1816 patients from 53 centers. Delta-PP and Delta-PostPP for PaO2/FiO2 were both associated with ICU mortality [OR (95% CI) 0.48 (0.38, 0.59), and OR (95% CI) 0.60 (0.52, 0.68), respectively]. Ventilatory ratio had a non-linear relationship with ICU mortality for Delta-PP (p = 0.022) and Delta-PostPP (p = 0.004). Delta-PP, while not Delta-PostPP, for Crs was associated with ICU mortality [OR (95% CI) 0.80 (0.65, 0.98)]. The length of the first cycle of prone position showed an inverse relationship with ICU mortality [OR (95% CI) 0.82 (0.73, 0.91)]. At the multivariable analysis, the duration of the first cycle of prone position, Delta-PP and Delta-PostPP for PaO2/FiO2, and Delta-PostPP for ventilatory ratio were independently associated with ICU mortality. Conclusion In COVID-19 patients with acute respiratory failure receiving invasive mechanical ventilation and prone positioning, the physiological response to prone position is associated with ICU mortality. Prolonging the duration of the first cycle of prone position is associated with improved survival.https://doi.org/10.1186/s13613-025-01438-yProne positionMechanical ventilationAcute respiratory failureArterial partial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2)Ventilatory ratioRespiratory system compliance |
| spellingShingle | Silvia De Rosa Nicolò Sella Giacomo Bellani Giuseppe Foti Andrea Cortegiani Giulia Lorenzoni Dario Gregori Annalisa Boscolo Lucia Cattin Muhammed Elhadi Giorgio Fullin Eugenio Garofalo Leonardo Gottin Alberto Grassetto Salvatore Maurizio Maggiore Elena Momesso Mario Peta Daniele Poole Roberto Rona Ivo Tiberio Andrea Zanoletti Emanuele Rezoagli Paolo Navalesi for the SIAARTI Study Group Oxygenation improvement and duration of prone positioning are associated with ICU mortality in mechanically ventilated COVID-19 patients Annals of Intensive Care Prone position Mechanical ventilation Acute respiratory failure Arterial partial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2) Ventilatory ratio Respiratory system compliance |
| title | Oxygenation improvement and duration of prone positioning are associated with ICU mortality in mechanically ventilated COVID-19 patients |
| title_full | Oxygenation improvement and duration of prone positioning are associated with ICU mortality in mechanically ventilated COVID-19 patients |
| title_fullStr | Oxygenation improvement and duration of prone positioning are associated with ICU mortality in mechanically ventilated COVID-19 patients |
| title_full_unstemmed | Oxygenation improvement and duration of prone positioning are associated with ICU mortality in mechanically ventilated COVID-19 patients |
| title_short | Oxygenation improvement and duration of prone positioning are associated with ICU mortality in mechanically ventilated COVID-19 patients |
| title_sort | oxygenation improvement and duration of prone positioning are associated with icu mortality in mechanically ventilated covid 19 patients |
| topic | Prone position Mechanical ventilation Acute respiratory failure Arterial partial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2) Ventilatory ratio Respiratory system compliance |
| url | https://doi.org/10.1186/s13613-025-01438-y |
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