Annals of Intensive Care volume 14 , Article number: Cite this article. Metrics details. A Correction to this article was published on 11 September Previous retrospective research has shown that maintaining prone positioning PP for an average of 40 h is associated with an increase of survival rates in intubated patients with COVIDrelated acute respiratory distress syndrome ARDS.
This study aims to determine whether a cumulative PP duration of more than 32 h during the first 2 days of intensive care unit ICU admission is associated with increased survival compared to a cumulative PP duration of 32 h or less. This study is an ancillary analysis from a previous large international observational study involving intubated patients placed in PP in the first 48 h of ICU admission in ICUs across France, Belgium and Switzerland.
Given that PP is recommended for a h daily duration, intensive PP was defined as a cumulated duration of more than 32 h during the first 48 h, whereas standard PP was defined as a duration equal to or less than 32 h. Patients were followed-up for 90 days. The primary outcome was mortality at day Sixty-day mortality rate in the intensive PP group was Twenty-eight-day and day mortality as well as the ventilator-free days until day 28 were similar in both groups.
Previous research has shown that early implementation of multiple h sessions of PP in patients with moderate to severe ARDS was associated with reduced mortality, leading to updated French guidelines for managing ARDS patients [ 4 , 5 ]. Moreover, PP increases the workload of ICU staff and is associated with certain risks, including pressure sores, potential hindrance to enteral nutrition and a higher rate of catheter-related blood stream infection [ 8 ].
Those risks potentially increase with the duration of each PP session. The objective of this ancillary study was to assess the outcomes of intubated patients with COVID related ARDS based on the cumulated duration of prone position during the first 48 h following ICU admission, using a large international cohort [ 2 ]. This secondary analysis focused on the subgroup of intubated patients who were consecutively turned prone during the first 48 h after ICU admission.
