OBJECTIVES:To assess the association of timing to prone positioning (PP) during venovenous extracorporeal membrane oxygenation (V-V ECMO) with the probability of being discharged alive from the ICU at 90 days (primary endpoint) and the improvement of the respiratory system compliance (Cpl,rs). DESIGN:Pooled individual data analysis from five original observational cohort studies. SETTING:European extracorporeal membrane oxygenation (ECMO) centers. PATIENTS:Acute respiratory distress syndrome (ARDS) patients who underwent PP during ECMO. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Time to PP during V-V ECMO was explored both as a continuous and a categorical variable with Cox proportional hazard models. Three hundred patients were included in the analysis. The longer the time to PP during V-V ECMO, the lower the adjusted probability of alive ICU discharge (adjusted hazard ratio [HR] 0.90 for each day increase; 95% CI, 0.87-0.93). Two hundred twenty-three and 77 patients were included in the early PP (<= 5 d) and late PP (> 5 d) groups, respectively. The cumulative 90-day probability of being discharged alive from the ICU was 61% in the early PP group vs 36% in the late PP group (log-rank test, p <0.001). This benefit was maintained after adjustment for confounders (adjusted HR, 2.52; 95% CI, 1.66-3.81; p <0.001). In the early PP group, PP was associated with a significant improvement of Cpl,rs (4 +/- 9 mL/cm H2O vs 0 +/- 12 in the late PP group, p=0.038). CONCLUSIONS:In a large cohort of ARDS patients on ECMO, early PP during ECMO was associated with a higher probability of being discharged alive from the ICU at 90 days and a greater improvement of Cpl,rs.

Timing of Prone Positioning During Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome / M. Giani, E. Rezoagli, C. Guervilly, J. Rilinger, T. Duburcq, M. Petit, L. Textoris, B. Garcia, T. Wengenmayer, G. Bellani, G. Grasselli, A. Pesenti, A. Combes, G. Foti, M. Schmidt. - In: CRITICAL CARE MEDICINE. - ISSN 0090-3493. - 51:1(2023 Jan 01), pp. 25-35. [10.1097/CCM.0000000000005705]

Timing of Prone Positioning During Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome

G. Grasselli;A. Pesenti;
2023

Abstract

OBJECTIVES:To assess the association of timing to prone positioning (PP) during venovenous extracorporeal membrane oxygenation (V-V ECMO) with the probability of being discharged alive from the ICU at 90 days (primary endpoint) and the improvement of the respiratory system compliance (Cpl,rs). DESIGN:Pooled individual data analysis from five original observational cohort studies. SETTING:European extracorporeal membrane oxygenation (ECMO) centers. PATIENTS:Acute respiratory distress syndrome (ARDS) patients who underwent PP during ECMO. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Time to PP during V-V ECMO was explored both as a continuous and a categorical variable with Cox proportional hazard models. Three hundred patients were included in the analysis. The longer the time to PP during V-V ECMO, the lower the adjusted probability of alive ICU discharge (adjusted hazard ratio [HR] 0.90 for each day increase; 95% CI, 0.87-0.93). Two hundred twenty-three and 77 patients were included in the early PP (<= 5 d) and late PP (> 5 d) groups, respectively. The cumulative 90-day probability of being discharged alive from the ICU was 61% in the early PP group vs 36% in the late PP group (log-rank test, p <0.001). This benefit was maintained after adjustment for confounders (adjusted HR, 2.52; 95% CI, 1.66-3.81; p <0.001). In the early PP group, PP was associated with a significant improvement of Cpl,rs (4 +/- 9 mL/cm H2O vs 0 +/- 12 in the late PP group, p=0.038). CONCLUSIONS:In a large cohort of ARDS patients on ECMO, early PP during ECMO was associated with a higher probability of being discharged alive from the ICU at 90 days and a greater improvement of Cpl,rs.
acute respiratory distress syndrome; intensive care unit discharge; extracorporeal membrane oxygenation; prone positioning; respiratory mechanics
Settore MED/41 - Anestesiologia
1-gen-2023
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/970818
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