Declining Use of Prone Positioning After High Initial Uptake in COVID-19 Adult Respiratory Distress Syndrome.
Declining Use of Prone Positioning After High Initial Uptake in COVID-19 Adult Respiratory Distress Syndrome.
复制标题
COVID-19 成人呼吸窘迫综合征患者初始摄入量较高后，俯卧位的使用逐渐减少。
DOI：
10.1097/ccm.0000000000005969
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发表时间：
2023
影响因子：
8.8
通讯作者：
Hager,DavidN
中科院分区：
文献类型：
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作者：
Hochberg,ChadH;Psoter,KevinJ;Eakin,MichelleN;Hager,DavidN
注意事项：急性呼吸窘迫综合征（ARDS）的俯卧位历来未得到充分使用，但在大流行早期被广泛用于COVID-19相关的ARDS。在COVID-19大流行的前三年，这一成功实施是否得以持续尚不清楚。在这项研究中，我们描述了2020年3月至2022年12月COVID-19 ARDS患者的俯卧使用。设计：多中心回顾性观察性研究。设置：美国马里兰州的五家医院卫生系统。患者：接受有创机械通气支持的COVID-19成人，P a o 2/F io 2比值小于或等于150 mmHg，同时在插管后72小时内接受F io 2大于或等于0.6。干预：无。测量：我们从电子病历中提取人口统计学、临床和定位数据。主要结局是在符合标准的48小时内开始俯卧。我们用单变量和多变量相对危险度（RR）回归比较了按年的俯卧使用。此外，我们评估了COVID-19激增期间的治疗与接受俯卧位的相关性。主要结果：我们确定了656名合格患者; 2020年有341名，2021年有224名，2022年有91名。超过一半（53%）符合严重ARDS标准。2020年、2021年和2022年分别有56.2%、56.7%和27.5%的患者发生了早期俯卧。这意味着2022年与2020年相比，接受治疗的患者中俯卧位的使用减少了51%（RR= 0.49; 95%CI，0.33-0.72; p< 0.001）。在调整后的模型中，这种降低仍然显著（调整后的RR= 0.59; 95% CI，0.42-0.82; p= 0.002）。COVID-19高峰期的治疗与俯卧位使用增加7%相关（调整后的RR= 1.07; 95%CI，1.02-1.13; p= 0.01）。结论：COVID-19 ARDS的俯卧位使用正在下降。有必要采取干预措施，增加和维持这种循证疗法的适当使用。
OBJECTIVES:Prone positioning for acute respiratory distress syndrome (ARDS) has historically been underused, but was widely adopted for COVID-19-associated ARDS early in the pandemic. Whether this successful implementation has been sustained over the first 3 years of the COVID-19 pandemic is unknown. In this study, we characterized proning use in patients with COVID-19 ARDS from March 2020 to December 2022.DESIGN:Multicenter retrospective observational study.SETTING:Five-hospital health system in Maryland, USA.PATIENTS:Adults with COVID-19 supported with invasive mechanical ventilation and with a P a o 2/F io 2 ratio of less than or equal to 150 mm Hg while receiving F io 2 of greater than or equal to 0.6 within 72 hours of intubation.INTERVENTIONS:None.MEASUREMENTS:We extracted demographic, clinical, and positioning data from the electronic medical record. The primary outcome was the initiation of proning within 48 hours of meeting criteria. We compared proning use by year with univariate and multivariate relative risk (RR) regression. Additionally, we evaluated the association of treatment during a COVID-19 surge period and receipt of prone positioning.MAIN RESULTS:We identified 656 qualifying patients; 341 from 2020, 224 from 2021, and 91 from 2022. More than half (53%) met severe ARDS criteria. Early proning occurred in 56.2% of patients in 2020, 56.7% in 2021, and 27.5% in 2022. This translated to a 51% reduction in use of prone positioning among patients treated in 2022 versus 2020 (RR= 0.49; 95% CI, 0.33–0.72; p< 0.001). This reduction remained significant in adjusted models (adjusted RR= 0.59; 95% CI, 0.42–0.82; p= 0.002). Treatment during COVID-19 surge periods was associated with a 7% increase in proning use (adjusted RR= 1.07; 95% CI, 1.02–1.13; p= 0.01).CONCLUSIONS:The use of prone positioning for COVID-19 ARDS is declining. Interventions to increase and sustain appropriate use of this evidence-based therapy are warranted.