You searched for:"Oscar Orlando Sanabria-Rodríguez"
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Original Article
Factors associated with a nonresponse to prone positioning in patients with severe acute respiratory distress syndrome due to SARS-CoV-2
Crit Care Sci. 2023;35(2):156-162
Abstract
Original ArticleFactors associated with a nonresponse to prone positioning in patients with severe acute respiratory distress syndrome due to SARS-CoV-2
Crit Care Sci. 2023;35(2):156-162
DOI 10.5935/2965-2774.20230343-pt
Views7ABSTRACT
Objective:
To identify risk factors for nonresponse to prone positioning in mechanically ventilated patients with COVID-19-associated severe acute respiratory distress syndrome and refractory hypoxemia in a tertiary care hospital in Colombia.
Methods:
Observational study based on a retrospective cohort of mechanically ventilated patients with severe acute respiratory distress syndrome due to SARS-CoV-2 who underwent prone positioning due to refractory hypoxemia. The study considered an improvement ≥ 20% in the PaO2/FiO2 ratio after the first cycle of 16 hours in the prone position to be a ‘response’. Nonresponding patients were considered cases, and responding patients were controls. We controlled for clinical, laboratory, and radiological variables.
Results:
A total of 724 patients were included (58.67 ± 12.37 years, 67.7% males). Of those, 21.9% were nonresponders. Mortality was 54.1% for nonresponders and 31.3% for responders (p < 0.001). Variables associated with nonresponse were time from the start of mechanical ventilation to pronation (OR 1.23; 95%CI 1.10 - 1.41); preintubation PaO2/FiO2 ratio (OR 0.62; 95%CI 0.40 – 0.96); preprone PaO2/FiO2 ratio (OR 1.88. 95%CI 1.22 – 2.94); and radiologic multilobe consolidation (OR 2.12; 95%CI 1.33 – 3.33) or mixed pattern (OR 1.72; 95%CI 1.07 – 2.85) compared with a ground-glass pattern.
Conclusion:
This study identified factors associated with nonresponse to prone positioning in patients with refractory hypoxemia and acute respiratory distress syndrome due to SARS-CoV-2 receiving mechanical ventilation. Recognizing such factors helps identify candidates for other rescue strategies, including more extensive prone positioning or extracorporeal membrane oxygenation. Further studies are needed to assess the consistency of these findings in populations with acute respiratory distress syndrome of other etiologies.
Keywords:artificialCoronavirus infectionsCOVID-19HypoxiaintratrachealIntubationProne positionRespirationRespiratory distress syndromeSARS-CoV-2See more
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness Extracorporeal membrane oxygenation Infant, newborn Intensive care Intensive care units Intensive care units, pediatric mechanical ventilation Mortality Physical therapy modalities Prognosis Respiration, artificial Respiratory insufficiency risk factors SARS-CoV-2 Sepsis