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10.1016/j.bja.2020.09.042

http://scihub22266oqcxt.onion/10.1016/j.bja.2020.09.042
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suck abstract from ncbi


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pmid33158500      Br+J+Anaesth 2021 ; 126 (1): 48-55
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  • Prone positioning for patients intubated for severe acute respiratory distress syndrome (ARDS) secondary to COVID-19: a retrospective observational cohort study #MMPMID33158500
  • Weiss TT; Cerda F; Scott JB; Kaur R; Sungurlu S; Mirza SH; Alolaiwat AA; Kaur R; Augustynovich AE; Li J
  • Br J Anaesth 2021[Jan]; 126 (1): 48-55 PMID33158500show ga
  • BACKGROUND: The role of repeated prone positioning in intubated subjects with acute respiratory distress syndrome caused by COVID-19 remains unclear. METHODS: We conducted a retrospective observational cohort study of critically ill intubated patients with COVID-19 who were placed in the prone position between March 18, 2020 and March 31, 2020. Exclusion criteria were pregnancy, reintubation, and previous prone positioning at a referring hospital. Patients were followed up until hospital discharge. The primary outcome was oxygenation assessed by partial pressure of oxygen/fraction of inspired oxygen ratio (Pao(2)/Fio(2)) ratio. A positive response to proning was defined as an increase in Pao(2)/Fio(2) ratio >/=20%. Treatment failure of prone positioning was defined as death or requirement for extracorporeal membrane oxygenation (ECMO). RESULTS: Forty-two subjects (29 males; age: 59 [52-69] yr) were eligible for analysis. Nine subjects were placed in the prone position only once, with 25 requiring prone positioning on three or more occasions. A total of 31/42 (74%) subjects survived to discharge, with five requiring ECMO; 11/42 (26%) subjects died. After the first prone positioning session, Pao(2)/Fio(2) (mean (standard deviation)) ratio increased from 17.9 kPa (7.2) to 28.2 kPa (12.2) (P<0.01). After the initial prone positioning session, subjects who were discharged from hospital were more likely to have an improvement in Pao(2)/Fio(2) ratio >/=20%, compared with those requiring ECMO or who died. CONCLUSION: Patients with COVID-19 acute respiratory distress syndrome frequently responded to initial prone positioning with improved oxygenation. Subsequent prone positioning in subjects discharged from hospital was associated with greater improvements in oxygenation.
  • |Aged[MESH]
  • |COVID-19/complications/physiopathology/*therapy[MESH]
  • |Cohort Studies[MESH]
  • |Female[MESH]
  • |Follow-Up Studies[MESH]
  • |Humans[MESH]
  • |Intubation, Intratracheal/*methods[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Prone Position/*physiology[MESH]
  • |Respiratory Distress Syndrome/etiology/physiopathology/*therapy[MESH]
  • |Respiratory Mechanics/*physiology[MESH]


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