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Background The role of prone positioning in intubated subjects with acute respiratory distress syndrome caused by coronavirus disease 2019 (COVID-19) remains unclear Methods We conducted an observational cohort study of intubated patients admitted to our academic medical centre intensive care unit with COVID-19 between March 18-31 2020 Exclusion criteria were pregnancy, reintubation and previous prone positioning at a referring hospital Patients that were placed in the prone position were followed up until hospital discharge The primary outcome was oxygenation assessed by arterial oxygen tension/fraction of inspired oxygen ratio (PaO2/FIO2) Secondary outcomes included PaO2/FIO2 ratio improvement ≥20% Treatment failure of prone positioning was defined as death or requirement for extracorporeal membrane oxygenation (ECMO) Results Forty-two subjects (29 males;mean age:58 5 [12 7] years) were eligible for analysis Nine subjects were placed in the prone position only once, with 25 requiring prone positioning on ≥3 occasions 31/42 (74%) subjects survived to discharge, with 5 requiring ECMO;11/42 (26 2%) subjects died Following the first prone positioning session, mean (SD) PaO2/FIO2 ratio increased from 17 9kPa (7 2) to 28 2kPa (12 2) (p<0 01) With repeated prone positioning sessions, 31/42 (73 8%) subjects who were discharged from hospital had PaO2/FIO2 ratio improvement of ≥20%, compared to 11/42 subjects who either died or required ECMO (odds ratio:XX (95% confidence intervals:xx-xx)) Conclusion Patients with COVID-19 ARDS frequently responded to initial prone positioning with improved oxygenation Subsequent prone positioning in subjects discharged from hospital was associated with greater improvements in oxygenation
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British_Journal_of_Anaesthesia
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Prone Positioning for Patients Intubated for Severe Acute Respiratory Distress Syndrome (ARDS) Secondary to COVID-19: observational cohort study
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