Influence of Prone Position on the Survival of COVID-19 Patients Undergoing Invasive Mechanical Ventilation: A Propensity Score Matching Study.

Abstract

Purpose: The role of prone position (PP) in critically ill patients diagnosed with coronavirus disease 2019 (COVID-19) undergoing invasive mechanical ventilation remains unclear. This study aimed to evaluate the potential prognostic benefits of PP.

Patients and methods: This retrospective study included data from 289 critically ill patients with COVID-19 who underwent invasive mechanical ventilation in a multicenter setting. Propensity score matching was used to match 156 patients (78 PP-treated, 78 non-PP-treated) after adjusting for age, sex, underlying disease, and Sequential Organ Failure Assessment score. Between-group comparisons of clinical data, laboratory results, and prognosis were performed. Kaplan-Meier (K-M) survival curve and univariate and multivariate Cox regression analyses were used to explore the relationship between PP and prognosis.

Results: Prone positioning improved oxygenation (oxygenation index in the PP group increased consistently, with the greatest improvement observed on days 12-13 compared with the non-PP group [48 vs 32 mmHg; P < 0.001]) and increased hospital survival (80.8% vs 65.4%; P = 0.047). K-M survival curve analysis revealed that patients treated with PP had a more favorable prognosis (P = 0.025). Multivariate Cox regression revealed that PP was linked to lower risk of death (HR 0.389 [95% CI 0.173-0.878]), while age (HR 1.053 [95% CI 1.012-1.096]), Acute Physiology and Chronic Health Evaluation II score (HR 1.055 [95% CI 1.006-1.107]), and troponin T levels (HR 2.028 [95% CI 1.222-3.367]) were linked to higher risk of death in the overall survival of patients with COVID-19.

Conclusion: PP improved oxygenation and increased the survival rate of critically ill patients with COVID-19 undergoing invasive mechanical ventilation. Adopting PP as much as possible during nursing care may enhance patient survival.