Efecto de la duración del decúbito prono en pacientes con SDRA durante la pandemia por SARS-CoV-2

Abstract

ObjectiveTo describe the characteristics of patients with acute respiratory distress syndrome due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV) and analyze the effect of prolonged prone decubitus>24h (PPD) compared to prone decubitus<24h (PD). DesignRetrospective observational descriptive study. Uni and bivariate analysis. SettingDepartment of Intensive Care Medicine. General University Hospital of Elche. ParticipantsPatients with SARS-CoV-2 pneumonia (2020–2021) in VMI for moderate-severe acute respiratory distress syndrome, ventilated in PD. InterventionsIMV. PD maneuvers. Main variables of interestSociodemographic; analgo-sedation; neuromuscular blockade; PD (duration), ICU stay and mortality, days of IMV; non-infectious complications; health care-associated infections. ResultsFifty-one patients required PD and of these 31 (69.78%) required PPD. No differences were found in patient characteristics (sex, age, comorbidities, initial severity, antiviral and anti-inflammatory treatment received). Patients on PPD had lower tolerance to supine ventilation (61.29 vs. 89.47%, p=0.031), longer hospital stay (41 vs. 30 days, p=0.023), more days of IMV (32 vs. 20 days, p=0.032), longer duration of neuromuscular blockade (10.5 vs. 3 days, p=0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39 vs. 15%, p=0.014). ConclusionsPPD was associated with higher resource use and complications in patients with moderate-severe acute respiratory distress syndrome by COVID-19.