Prone Positioning and Survival in Mechanically Ventilated Patients With Coronavirus Disease 2019–Related Respiratory Failure*

作者：Kusum S. Mathews, Howard Soh, Shahzad Shaefi, Wei Wang, Sonali Bose, Steven G. Coca, Shruti Gupta, Salim S. Hayek, Anand Shanker Srivastava, Samantha K. Brenner, Jared Radbel, Adam Green, Anne K. Sutherland, Amanda K. Leonberg‐Yoo, Alexandre M. Shehata, Edward James Schenck, Samuel Short, Miguel Ángel Hernán, Lili Chan, David E. Leaf · 发表于：Critical Care Medicine · 年份：2021 · DOI：10.1097/ccm.0000000000004938 · 被引用次数：120 · 研究领域：Respiratory Support and Mechanisms、Pneumothorax, Barotrauma, Emphysema、Intensive Care Unit Cognitive Disorders

OBJECTIVES: Therapies for patients with respiratory failure from coronavirus disease 2019 are urgently needed. Early implementation of prone positioning ventilation improves survival in patients with acute respiratory distress syndrome, but studies examining the effect of proning on survival in patients with coronavirus disease 2019 are lacking. Our objective was to estimate the effect of early proning initiation on survival in patients with coronavirus disease 2019-associated respiratory failure. DESIGN: Data were derived from the Study of the Treatment and Outcomes in Critically Ill Patients with coronavirus disease 2019, a multicenter cohort study of critically ill adults with coronavirus disease 2019 admitted to 68 U.S. hospitals. Using these data, we emulated a target trial of prone positioning ventilation by categorizing mechanically ventilated hypoxemic (ratio of Pao2 over the corresponding Fio2 ≤ 200 mm Hg) patients as having been initiated on proning or not within 2 days of ICU admission. We fit an inverse probability-weighted Cox model to estimate the mortality hazard ratio for early proning versus no early proning. Patients were followed until death, hospital discharge, or end of follow-up. SETTING: ICUs at 68 U.S. sites. PATIENTS: Critically ill adults with laboratory-confirmed coronavirus disease 2019 receiving invasive mechanical ventilation with ratio of Pao2 over the corresponding Fio2 less than or equal to 200 mm Hg. INTERVENTIONS: None. MEASUREMENTS AND MAIN...