ae804acfb9f32550578bb4381371d313 pmc_9739110.pdf 19f3c1f5cda3b178e28f1a62957cf0456961e634 pmc_9739110.pdf 73051dde20ad0fba3efea7ca5a7bcb092d4180601495fa9ece5fadef59dcfaed pmc_9739110.pdf Title: Practice of Awake Prone Positioning in Critically Ill COVID-19 Patients—Insights from the PRoAcT–COVID Study Subject: We describe the incidence, practice and associations with outcomes of awake prone positioning in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) in a national multicenter observational cohort study performed in 16 intensive care units in the Netherlands (PRoAcT–COVID-study). Patients were categorized in two groups, based on received treatment of awake prone positioning. The primary endpoint was practice of prone positioning. Secondary endpoint was ‘treatment failure’, a composite of intubation for invasive ventilation and death before day 28. We used propensity matching to control for observed confounding factors. In 546 patients, awake prone positioning was used in 88 (16.1%) patients. Prone positioning started within median 1 (0 to 2) days after ICU admission, sessions summed up to median 12.0 (8.4–14.5) hours for median 1.0 day. In the unmatched analysis (HR, 1.80 (1.41–2.31); p < 0.001), but not in the matched analysis (HR, 1.17 (0.87–1.59); p = 0.30), treatment failure occurred more often in patients that received prone positioning. The findings of this study are that awake prone positioning was used in one in six COVID-19 patients. Prone positioning started early, and sessions lasted long but were often discontinued because of need for intubation. Keywords: coronavirus disease 2019; COVID-19; acute hypoxemic respiratory failure; awake prone positioning; self-proning; prone positioning; outcome; propensity matching Author: Willemke Stilma, Christel M. A. Valk, David M. P. van Meenen, Luis Morales, Daantje Remmelzwaal, Sheila N. Myatra, Antonio Artigas, Ary Serpa Neto, Frederique Paulus and Marcus J. Schultz Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Wed Nov 30 03:10:46 2022 CET ModDate: Wed Nov 30 03:16:21 2022 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 12 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 788769 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- PMZFBW+VnURWPalladioL Type 1 Custom yes yes no 10 0 ETBNAJ+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 NDZAAT+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 UVRHOG+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 42 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 45 0 AOPHAZ+CMSY10 Type 1 Builtin yes yes no 70 0 MHIKJJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 89 0 MHIKJL+PalatinoLinotype TrueType WinAnsi yes yes no 92 0 MHIKJN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 95 0 MHIMLC+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 98 0 FAECIJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 105 0 LLFELJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 115 0 LLFEML+PalatinoLinotype TrueType WinAnsi yes yes no 118 0 LLFEMN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 121 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-09-07 02:29:22 CEST RepresentationInformation: pmc_9739110.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-08-03 02:25:11 CEST Size: 788769 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 278 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Children: Item: Title: Study Design Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Patients Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Collected Data Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Patient Classification Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Endpoints Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Power Calculation Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Statistical Analyses Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Children: Item: Title: Patients Enrolled Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Practice of Awake Prone Positioning Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Epidemiology Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Treatment Failure Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Item: Title: Other Outcomes Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Propensity Matched Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@76a3e297 Item: Title: Appendix A Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4d3167f4 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@ed9d034 Info: Title: Practice of Awake Prone Positioning in Critically Ill COVID-19 Patients Insights from the PRoAcT COVID Study Author: Willemke Stilma, Christel M. A. Valk, David M. P. van Meenen, Luis Morales, Daantje Remmelzwaal, Sheila N. Myatra, Antonio Artigas, Ary Serpa Neto, Frederique Paulus and Marcus J. Schultz Subject: We describe the incidence, practice and associations with outcomes of awake prone positioning in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) in a national multicenter observational cohort study performed in 16 intensive care units in the Netherlands (PRoAcT COVID-study). Patients were categorized in two groups, based on received treatment of awake prone positioning. The primary endpoint was practice of prone positioning. Secondary endpoint was ‘treatment failure’, a composite of intubation for invasive ventilation and death before day 28. We used propensity matching to control for observed confounding factors. In 546 patients, awake prone positioning was used in 88 (16.1%) patients. Prone positioning started within median 1 (0 to 2) days after ICU admission, sessions summed up to median 12.0 (8.4 14.5) hours for median 1.0 day. In the unmatched analysis (HR, 1.80 (1.41 2.31); p < 0.001), but not in the matched analysis (HR, 1.17 (0.87 1.59); p = 0.30), treatment failure occurred more often in patients that received prone positioning. The findings of this study are that awake prone positioning was used in one in six COVID-19 patients. Prone positioning started early, and sessions lasted long but were often discontinued because of need for intubation. 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