Background Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. Methods Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO 2 /FiO 2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position. Results Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p < 0.001). Overall, prone position induced a significant increase in PaO 2 /FiO 2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders . Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs . 38%, p = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders . These patients were older and had more comorbidities; however, no difference in terms of ICU mortality was observed (51% vs . 37%, p = 0.189 for Carbon Dioxide Responders and Non-Responders , respectively). Conclusions During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching. Trial registration : clinicaltrials.gov number: NCT04388670 Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03552-2.
【저자키워드】 COVID-19, mechanical ventilation, prone positioning, Refractory hypoxemia, 【초록키워드】 Prone position, pandemic, Respiratory failure, Mortality, prone, COVID-19 pandemic, severe respiratory failure, Ventilation, intensive care unit, outcome, ICU, cohort study, clinical, Patient, ICU admission, Compliance, Mild, multicentre, Respiratory system, moderate, patients, Invasive mechanical ventilation, severe disease, Oxygenation, Older, Intubated, supplementary material, significant increase, no difference, severe ARDS, ventilatory, treat, National, carbon, Effect, Italian, dioxide, Result, defined, resulting, collected, caused, significantly more, died, conducted, was collected, applied, was performed, majority, adopted, subset, was reduced, had more, invasively ventilated patient, Limited, mechanically ventilated patient, PaO, 【제목키워드】 prone, Patient, Intubated, mechanically ventilated patient,