Extended Prone Position Duration COVID-19-related ARDS: a Retrospective Study

Hôpital Louis Mourier

Status: Completed

Conditions: Respiratory Distress Syndrome, Acute; COVID-19 Acute Respiratory Distress Syndrome; Hypoxemic Respiratory Failure; Pressure Ulcer

Treatments: Other: prone position

Study type: Observational

Funder types: Other

Identifiers

NCT05124197

HLM_JDR10

Details and patient eligibility

About

Prone position (PP) is standard of care for mechanically ventilated patients with severe acute respiratory distress syndrome in the intensive care unit (ICU). Recommendations suggest PP durations of at least 16 hours. In 2020, COVID-19 pandemic led to a great number of patients requiring mechanical ventilation and PP in the ICU. Risk of ICU staff viral contamination and work overload led to prolongation of PP duration up to 48 hours. Here investigators report outcomes of prolonged PP sessions in terms of skin complications (pression injuries) and ventilatory improvement.

Full description

Acute respiratory distress syndrome (ARDS) is a severe condition in which diffuse ventilation/perfusion mismatching and intra-pulmonary shunt are responsible for profound hypoxemia. In patients with severe ARDS, prone position (PP) improves oxygenation and reduces mortality. Recommendations suggest that PP sessions should last at least 16 consecutive hours. Safety concern is mainly related to the risk of pressure injuries.

In 2020, COVID-19 pandemic led to a great number of patients requiring mechanical ventilation (MV) and PP in the Intensive Care Units (ICUs) worldwide.

In the ICU of Louis Mourier hospital (Colombes, France) investigators decided upon a strategy whereby PP sessions duration was extended up to 48 hours in patients with COVID-19-related ARDS, so as to minimize the number and workload of turning procedures, limit staff exposure to viral contamination, and avoid turning patients during night shifts.

Here, investigators aim to report incidence of skin complications (pression injuries) in patients who underwent at least one prolonged PP session. Secondary objective was to evaluate evolution of ventilatory parameters with prolonged PP sessions.

Enrollment: 81 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• COVID-19 proven by PCR-testing of respiratory specimen
• Acute respiratory distress syndrome (Berlin definition) requiring invasive mechanical ventilation and prone position
• at least one session of prolonged prone position (that includes two consecutive nights in prone position)

Exclusion criteria

• transfer to another ICU facility after initial admission (inter-regional regulation of ICU beds' availability)

  • Incomplete or missing medical file
  • Refusal to consent

Trial design

81 participants in 1 patient group

Cohort of ICU patients with COVID-19 related ARDS requiring at least one extended PP session

Description:

patients with COVID-19 related ARDS requiring prone position because of profound hypoxemia were applied the investigators' strategy to extend duration of prone position: after being turned prone, they spent at least two complete nights in prone position before being turned to supine position

Treatment:

Other: prone position