Table 2 Summary of the literature on extended prone positioning for COVID-related ARDS
From: Extended prone positioning for intubated ARDS: a review
References | Douglas et al. [9] | Walter et al. [8] | Okin et al. [10] | Cornejo et al. [48] |
|---|---|---|---|---|
Etiology | COVID-19 | COVID-19 | COVID-19 | COVID-19 |
Design | Retrospective | Retrospective | Retrospective | Retrospective |
Monocentric or multicentric | Monocentric | Monocentric | Multicentric | Multicentric |
Number of patients receiving extended prone positioning | 427 | 81 | 263 | 417 |
Country | United States | France | United States | Chile |
Effective prone positioning duration in hours (mean, SD or median and IQR) | 2.95 [1.8–5] days among survivors and 3.3 [2.4–6.6] days among non survivors | 39 [34–42] h | 40 [27–55] h | In patients who required only 1 session (75% of the cohort), the median duration was 4 [3, 4] days |
Criteria for stopping individual prone positioning sessions | FiO2 < 60% and PEEP levels < 10 cm d’H2O during > 4 h | Fixed duration: PP maintained over 2 nigths | To the discretion of the treating physician | At least 48 h and until P/F ≥ 200 mmHg |
Adjunctive therapy in case of COVID-19 related ARDS | Not specified | Dexamethasone and Tocilizumab | Remdesivir and Tocilizumab | Not specified |
PEEP level strategy | Based on ARDSnet “high” PEEP table | Minimum of 8 cm of H2O with a plateau pressure ≤ to 30 cm H2O | Set at best compliance or based on ARDSNet PEEP/FiO2table | No specific PEEP titration strategy |
PEEP before PP in cm of H2O (mean, SD or median and IQR) | 14 [12–18] | 12 [10–13] | 12 [10–14] | 10 [8–12] |
Cumulated incidence of pressure injuries | 72% | 25% | 29% | 36% |
Grades of the reported pressure injuries | Grade ≥ I | Grade ≥ II | Not reported | Grade I & II |