During the COVID-19 pandemic, many more patients were turned prone than before, resulting in a considerable increase in workload. Whether extending duration of prone position may be beneficial has received little attention. We report here benefits and detriments of a strategy of extended prone positioning duration for COVID-19-related acute respiratory distress syndrome (ARDS). A eetrospective, monocentric, study was performed on intensive care unit patients with COVID-19-related ARDS who required tracheal intubation and who have been treated with at least one session of prone position of duration greater or equal to 24 h. When prone positioning sessions were initiated, patients were kept prone for a period that covered two nights. Data regarding the incidence of pressure injury and ventilation parameters were collected retrospectively on medical and nurse files of charts. The primary outcome was the occurrence of pressure injury of stage ≥ II during the ICU stay. For the 81 patients included, the median duration of prone positioning sessions was 39 h [interquartile range (IQR) 34–42]. The cumulated incidence of stage ≥ II pressure injuries was 26% [95% CI 17–37] and 2.5% [95% CI 0.3–8.8] for stages III/IV pressure injuries. Patients were submitted to a median of 2 sessions [IQR 1–4] and for 213 (94%) prone positioning sessions, patients were turned over to supine position during daytime, i.e., between 9 AM and 6 PM. This increased duration was associated with additional increase in oxygenation after 16 h with the PaO2/FiO2 ratio increasing from 150 mmHg [IQR 121–196] at H+ 16 to 162 mmHg [IQR 124–221] before being turned back to supine (p = 0.017). In patients with extended duration of prone position up to 39 h, cumulative incidence for stage ≥ II pressure injuries was 26%, with 25%, 2.5%, and 0% for stage II, III, and IV, respectively. Oxygenation continued to increase significantly beyond the standard 16-h duration. Our results may have significant impact on intensive care unit staffing and patients’ respiratory conditions. Trial registration: Institutional review board 00006477 of HUPNVS, Université Paris Cité, APHP, with the reference: CER-2021-102, obtained on October 11th 2021. Registered at Clinicaltrials (NCT05124197).

中文翻译：

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延长 COVID-19 相关 ARDS 的俯卧位持续时间：利弊

在 COVID-19 大流行期间，比以往更多的患者变得俯卧，导致工作量大幅增加。延长俯卧位的持续时间是否有益，很少受到关注。我们在此报告 COVID-19 相关急性呼吸窘迫综合征 (ARDS) 延长俯卧位持续时间策略的利弊。对需要气管插管且已接受至少一次持续时间大于或等于 24 小时的俯卧位治疗的重症监护室 COVID-19 相关 ARDS 患者进行了一项透视、单中心研究。当开始俯卧位训练时，患者保持俯卧状态持续了两个晚上。回顾性收集有关压力损伤发生率和通气参数的数据，记录在医疗和护士图表文件中。主要结局是在ICU住院期间发生≥II期的压力性损伤。对于纳入的 81 名患者，俯卧位的中位持续时间为 39 小时 [四分位距 (IQR) 34-42]。≥ II 期压力损伤的累积发生率为 26% [95% CI 17–37] 和 III/IV 期压力损伤的 2.5% [95% CI 0.3–8.8]。患者接受了 2 次治疗的中位数 [IQR 1-4]，对于 213 次（94%）俯卧位治疗，患者在白天（即上午 9 点至下午 6 点之间）转为仰卧位。这种增加的持续时间与 16 小时后氧合的额外增加有关，PaO2/FiO2 比率从 H+ 16 时的 150 mmHg [IQR 121-196] 增加到 162 mmHg [IQR 124-221]，然后转回仰卧位（p = 0.017)。在俯卧位持续时间延长至 39 小时的患者中，≥ II 期压力损伤的累积发生率为 26%，II、III 和 IV 期分别为 25%、2.5% 和 0%。氧合持续显着增加超过标准的 16 小时持续时间。我们的结果可能会对重症监护室的人员配备和患者的呼吸状况产生重大影响。试验注册：HUPNVS 的机构审查委员会 00006477, Université Paris Cité, APHP，参考号：CER-2021-102，于 2021 年 10 月 11 日获得。在 Clinicaltrials 注册（NCT05124197）。