Predictors of prone position use in patients with COVID-19 acute respiratory distress syndrome in intensive care units: A cross-sectional study
-
Skarlet Marcell Vásquez
,
Olga Lucía Cortés
,
María del Pilar Paipa-Campos
,
Carolina Mójica-Diaz
,
Yudy Andrea Rojas-Castañeda
,
Sandra Patricia Pulido-Barragán
,
Martha Cecilia Arias-Portillo
,
Maribel Esparza-Bohorquez
,
Natalia Martínez
,
Indira Alba Arévalo-Sandoval
Abstract
Background & Aim: Clinical recommendations for ventilation management in patients with COVID-19 acute respiratory distress syndrome suggest the use of the prone position as a complementary therapy, however, there is wide variability in its use. The purpose of this study is to identify the predictor factors for using the prone position for patients hospitalized in intensive care units with COVID-19 acute respiratory distress syndrome.
Methods & Materials: A Cross-sectional study was carried out, including adult patients with COVID-19 acute respiratory distress syndrome hospitalized in intensive care units of four hospitals in Colombia. A multiple logistic regression model was constructed in which the main outcome was the prone position in intensive care, and the independent variables included sociodemographic characteristics, history, health status, progress, and treatment.
Results: A total of 473 patients were included in this study; 59.8% (n=283) received prone position therapy within 24-96 hours of hospitalization in intensive care. Out of the total of eligible variables in the logistics-regression model, factors in favor of the prone position were PCR>10mg/L (OR=3.33), private healthcare network (OR=1.99), hypertension (OR=1,76), cough or dyspnea symptoms at intensive care admission (OR=2.69 and OR=1.91), oxygen saturation <90% (OR=1.84). Factors against the prone position were heart disease (OR=0.34), FiO2>50% (OR=0.32), and TP>13 seconds (OR=0.53).
Conclusion: Patients with COVID-19 acute respiratory distress syndrome with a higher probability of prone position in intensive care were those with PCR>10mg/L, cough, dyspnea, and private healthcare network. The predictors identified in this study could help standardize the prone position therapy.
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8. Fazzini B, Page A, Pearse R, Puthucheary Z. Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis. British Journal of Anaesthesia. 2022 Feb 1;128(2):352-62.
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11. Binda F, Marelli F, Galazzi A, Pascuzzo R, Adamini I, Laquintana D. Nursing management of prone positioning in patients with COVID-19. Critical Care Nurse. 2021 Apr 1;41(2):27-35.
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15. Cotton S, Zawaydeh Q, LeBlanc S, Husain A, Malhotra A. Proning during covid-19: Challenges and solutions. Heart & Lung. 2020 Nov 1;49(6):686-7. doi: 10.1016/j.hrtlng.2020.08.006.
16. Fanelli V, Vlachou A, Ghannadian S, Simonetti U, Slutsky AS, Zhang H. Acute respiratory distress syndrome: new definition, current and future therapeutic options. Journal of thoracic disease. 2013 Jun;5(3):326-34. doi: 10.3978/j.issn.2072-1439.2013.04.05.
17. Carboni Bisso I, Huespe I, Lockhart C, Massó A, Gonzalez Anaya J, Hornos M, Famiglietti R, Di Grazia M, Coria P, San Román E, Las Heras M. Clinical characteristics of critically ill patients with COVID-19. Medicina (B Aires). 2021;81(4):527-35. English. PMID: 34453793.
18. Jain V, Yuan JM. Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis. International Journal of Public Health. 2020 Jun;65:533-46. doi: 10.1007/s00038-020-01390-7.
19. Li X, Zhong X, Wang Y, Zeng X, Luo T, Liu Q. Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis. PloS one. 2021 May 3;16(5):e0250602. doi: 10.1371/journal.pone.0250602.
20. Adeola JO, Patel S, Goné EN, Tewfik G. A Quick Review on the Multisystem Effects of Prone Position in Acute Respiratory Distress Syndrome (ARDS) Including COVID-19. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine. 2021 Jul;15:11795484211028526. doi: 10.1177/11795484211028526.
21. Zhang JJ, Lee KS, Ang LW, Leo YS, Young BE. Risk factors for severe disease and efficacy of treatment in patients infected with COVID-19: a systematic review, meta-analysis, and meta-regression analysis. Clinical Infectious Diseases. 2020 Oct 15;71(16):2199-206. doi: 10.1093/cid/ciaa576.
22. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, Fang C, Huang D, Huang LQ, Huang Q, Han Y. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military medical research. 2020 Dec;7(1):1-23.
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24. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines [Internet]. Bethesda (MD): National Institutes of Health (US); 2021. PMID: 34003615. [cited 2023 15 February]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570371/
25. Hilarión-Gaitán L, Díaz-Jiménez D, Cotes-Cantillo K, Castañeda-Orjuela C. Desigualdades en salud según régimen de afiliación y eventos notificados al Sistema de Vigilancia (Sivigila) en Colombia, 2015. Biomedica. 2019 Dec;39(4):737-47.
26. Garcia-Subirats I, Vargas I, Mogollón-Pérez AS, De Paepe P, Da Silva MR, Unger JP, Borrell C, Vázquez ML. Inequities in access to health care in different health systems: a study in municipalities of central Colombia and north-eastern Brazil. International Journal for Equity in Health. 2014 Dec;13(1):1-5.
27. Laajaj R, Webb D, Aristizabal D, Behrentz E, Bernal R, Buitrago G, Cucunubá Z, de la Hoz F, Gaviria A, Hernández LJ, De Los Rios C, Ramírez Varela A, Restrepo S, Schady N, Vives M. Understanding how socioeconomic inequalities drive inequalities in COVID-19 infections. Sci Rep. 2022 May 18;12(1):8269. doi: 10.1038/s41598-022-11706-7.
28. Almeida-Espinosa A, Sarmiento-Ardila JA. COVID-19: implications of SARS-CoV-2 in Colombia. Gaceta médica de México. 2020 Aug;156(4):330-4.
29. Lucchini A, Bambi S, Mattiussi E, Elli S, Villa L, Bondi H, Rona R, Fumagalli R, Foti G. Prone position in acute respiratory distress syndrome patients: a retrospective analysis of complications. Dimensions of Critical Care Nursing. 2020 Jan 1;39(1):39-46.
30. Bruni A, Garofalo E, Longhini F. Avoiding complications during prone position ventilation. Intensive Crit Care Nurs. 2021 Oct;66:103064. doi: 10.1016/j.iccn.2021.103064.
2. Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nature Reviews Microbiology. 2021 Mar;19(3):141-54.
3. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. The lancet. 2020 Mar 28;395(10229):1054-62.
4. Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P, Cairo M, Mori S, Messinesi G, Contro E, Bonfanti P. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): A prospective cohort study. The Lancet Respiratory Medicine. 2020 Aug 1;8(8):765-74.
5. Hu Y, Sun J, Dai Z, Deng H, Li X, Huang Q, Wu Y, Sun L, Xu Y. Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis. Journal of Clinical Virology. 2020 Jun 1;127:104371.
6. Ferrando C, Mellado-Artigas R, Gea A, Arruti E, Aldecoa C, Bordell A, Adalia R, Zattera L, Ramasco F, Monedero P, Maseda E. Características, evolución clínica y factores asociados a la mortalidad en UCI de los pacientes críticos infectados por SARS-CoV-2 en España: estudio prospectivo, de cohorte y multicéntrico. Revista Española de Anestesiología y Reanimación. 2020 Oct 1;67(8):425-37.
7. Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, Adhikari NK, Amato MB, Branson R, Brower RG, Ferguson ND. An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine. 2017 May 1;195(9):1253-63.
8. Fazzini B, Page A, Pearse R, Puthucheary Z. Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis. British Journal of Anaesthesia. 2022 Feb 1;128(2):352-62.
9. Bloomfield R, Noble DW, Sudlow A. Prone position for acute respiratory failure in adults. Cochrane database of systematic reviews. 2015(11):CD008095.doi: 10.1002/14651858.CD008095.pub2.
10. Weatherald J, Parhar KK, Al Duhailib Z, Chu DK, Granholm A, Solverson K, Lewis K, Møller MH, Alshahrani M, Belley-Cote E, Loroff N. Efficacy of awake prone positioning in patients with covid-19 related hypoxemic respiratory failure: Systematic review and meta-analysis of randomized trials. BMJ. 2022 Dec 7;379:e071966. doi: 10.1136/bmj-2022-071966.
11. Binda F, Marelli F, Galazzi A, Pascuzzo R, Adamini I, Laquintana D. Nursing management of prone positioning in patients with COVID-19. Critical Care Nurse. 2021 Apr 1;41(2):27-35.
12. Perez-Nieto OR, Escarraman-Martinez D, Guerrero-Gutierrez MA, Zamarron-Lopez EI, Mancilla-Galindo J, Kammar-García A, Martinez-Camacho MA, Deloya-Tomás E, Sanchez-Díaz JS, Macías-García LA, Soriano-Orozco R. Awake prone positioning and oxygen therapy in patients with COVID-19: the APRONOX study. European Respiratory Journal. 2022 Feb 1;59(2):2100265. doi: 10.1183/13993003.00265-2021.
13. Stilma W, Van Meenen DM, Valk CM, De Bruin H, Paulus F, Serpa Neto A, Schultz MJ, PRoVENT-COVID Collaborative Group. Incidence and Practice of Early Prone Positioning in Invasively Ventilated COVID-19 Patients—Insights from the PRoVENT-COVID Observational Study. Journal of Clinical Medicine. 2021 Oct 19;10(20):4783. doi: 10.3390/jcm10204783.
14. Klaiman T, Silvestri JA, Srinivasan T, Szymanski S, Tran T, Oredeko F, Sjoding MW, Fuchs BD, Maillie S, Jablonski J, Lane-Fall MB. Improving prone positioning for severe acute respiratory distress syndrome during the COVID-19 pandemic. An implementation-mapping approach. Annals of the American Thoracic Society. 2021 Feb;18(2):300-7. doi: 10.1513/AnnalsATS.202005-571OC.
15. Cotton S, Zawaydeh Q, LeBlanc S, Husain A, Malhotra A. Proning during covid-19: Challenges and solutions. Heart & Lung. 2020 Nov 1;49(6):686-7. doi: 10.1016/j.hrtlng.2020.08.006.
16. Fanelli V, Vlachou A, Ghannadian S, Simonetti U, Slutsky AS, Zhang H. Acute respiratory distress syndrome: new definition, current and future therapeutic options. Journal of thoracic disease. 2013 Jun;5(3):326-34. doi: 10.3978/j.issn.2072-1439.2013.04.05.
17. Carboni Bisso I, Huespe I, Lockhart C, Massó A, Gonzalez Anaya J, Hornos M, Famiglietti R, Di Grazia M, Coria P, San Román E, Las Heras M. Clinical characteristics of critically ill patients with COVID-19. Medicina (B Aires). 2021;81(4):527-35. English. PMID: 34453793.
18. Jain V, Yuan JM. Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis. International Journal of Public Health. 2020 Jun;65:533-46. doi: 10.1007/s00038-020-01390-7.
19. Li X, Zhong X, Wang Y, Zeng X, Luo T, Liu Q. Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis. PloS one. 2021 May 3;16(5):e0250602. doi: 10.1371/journal.pone.0250602.
20. Adeola JO, Patel S, Goné EN, Tewfik G. A Quick Review on the Multisystem Effects of Prone Position in Acute Respiratory Distress Syndrome (ARDS) Including COVID-19. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine. 2021 Jul;15:11795484211028526. doi: 10.1177/11795484211028526.
21. Zhang JJ, Lee KS, Ang LW, Leo YS, Young BE. Risk factors for severe disease and efficacy of treatment in patients infected with COVID-19: a systematic review, meta-analysis, and meta-regression analysis. Clinical Infectious Diseases. 2020 Oct 15;71(16):2199-206. doi: 10.1093/cid/ciaa576.
22. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, Fang C, Huang D, Huang LQ, Huang Q, Han Y. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military medical research. 2020 Dec;7(1):1-23.
23. World Health Organization. Clinical management Clinical management Living guidance COVID-19. 2021. [cited 2023 15 February]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-2
24. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines [Internet]. Bethesda (MD): National Institutes of Health (US); 2021. PMID: 34003615. [cited 2023 15 February]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570371/
25. Hilarión-Gaitán L, Díaz-Jiménez D, Cotes-Cantillo K, Castañeda-Orjuela C. Desigualdades en salud según régimen de afiliación y eventos notificados al Sistema de Vigilancia (Sivigila) en Colombia, 2015. Biomedica. 2019 Dec;39(4):737-47.
26. Garcia-Subirats I, Vargas I, Mogollón-Pérez AS, De Paepe P, Da Silva MR, Unger JP, Borrell C, Vázquez ML. Inequities in access to health care in different health systems: a study in municipalities of central Colombia and north-eastern Brazil. International Journal for Equity in Health. 2014 Dec;13(1):1-5.
27. Laajaj R, Webb D, Aristizabal D, Behrentz E, Bernal R, Buitrago G, Cucunubá Z, de la Hoz F, Gaviria A, Hernández LJ, De Los Rios C, Ramírez Varela A, Restrepo S, Schady N, Vives M. Understanding how socioeconomic inequalities drive inequalities in COVID-19 infections. Sci Rep. 2022 May 18;12(1):8269. doi: 10.1038/s41598-022-11706-7.
28. Almeida-Espinosa A, Sarmiento-Ardila JA. COVID-19: implications of SARS-CoV-2 in Colombia. Gaceta médica de México. 2020 Aug;156(4):330-4.
29. Lucchini A, Bambi S, Mattiussi E, Elli S, Villa L, Bondi H, Rona R, Fumagalli R, Foti G. Prone position in acute respiratory distress syndrome patients: a retrospective analysis of complications. Dimensions of Critical Care Nursing. 2020 Jan 1;39(1):39-46.
30. Bruni A, Garofalo E, Longhini F. Avoiding complications during prone position ventilation. Intensive Crit Care Nurs. 2021 Oct;66:103064. doi: 10.1016/j.iccn.2021.103064.
| Files | ||
| Issue | Vol 10 No 4 (2023): Autumn | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/npt.v10i4.14079 | |
| Keywords | ||
| COVID-19; clinical decision rules; intensive care units; prone position; respiratory distress syndrome; nursing care | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Vásquez S, Cortés O, Paipa-Campos M, Mójica-Diaz C, Rojas-Castañeda YA, Pulido-Barragán SP, Arias-Portillo MC, Esparza-Bohorquez M, Martínez N, Arévalo-Sandoval IA. Predictors of prone position use in patients with COVID-19 acute respiratory distress syndrome in intensive care units: A cross-sectional study. NPT. 2023;10(4):327-343.
