COVID-19 with acute respiratory failure: the best ventilation strategy in prone position

Why is this important?

The optimal duration of VDV in intubated patients with COVID-19 is, so far, unknown.

Methodology

A retrospective cohort study of 267 patients with COVID-19 and acute respiratory failure admitted consecutively to ICUs at 3 hospitals within the Mass General Brigham network in the Boston area, MA (period from March 11 to May 31, 2020).
Patients were assigned to prolonged VDV (24 hours or more in prone position before supine position) or intermittent VDV (approximately 16 hours in prone position with supine position daily).
Primary endpoint: 30-day all-cause mortality.
Funding: no funding has been communicated.

Principle results

Prolonged VDV was associated with 52.5% lower 30-day mortality compared to intermittent VDV (adjusted hazard ratio [RRc] : 0,475 ; P < 0,001), et à une mortalité toutes causes confondues à 90 jours 36,2 % plus faible (RRc : 0,638 ; P = 0,006).
In the subgroup of patients with severe acute respiratory distress syndrome before VDV (ratio of arterial oxygen partial pressure to inspired oxygen fraction less than or equal to 150), prolonged VDV was associated with 64.3% lower 30-day mortality, compared to intermittent VDV (RRc: 0.357; P < 0.001), and 43.8% lower all-cause mortality at 90 days (RRc: 0.562; P = 0.008).
Patients who received prolonged VDV experienced fewer prone and supine-related events (median: 1 versus 3 with intermittent VDV; P < 0.001).
Prolonged VDV was associated with an increased rate of facial edema (15.3% versus 6.4% with intermittent VDV; P = 0.04) and a lower rate of supine hypotension (1.3 % versus 7.3%, respectively; P = 0.03) as complications.

Limits