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The following is a summary of “Oxygenation improvement and duration of prone positioning are associated with ICU mortality in mechanically ventilated COVID-19 patients,” published in the January 2025 issue of Critical Care by Rosa et al. 

Researchers conducted a retrospective study to specify the association between the physiological response, the duration of the first prone positioning cycle, and intensive care unit (ICU) mortality in patients on mechanical ventilation with COVID-19.  

They utilized an international registry of individuals with COVID-19 who underwent prone positioning. The difference in arterial partial pressure of oxygen to inspired fraction of oxygen ratio (PaO₂ /FiO₂), respiratory system compliance (Crs) and ventilatory ratio, was measured between baseline supine position and either the end of the first cycle of prone position (Delta-PP) or after re-supination (Delta-PostPP).  

The results showed that 1,816 individuals from 53 centers were enrolled. Both Delta-PP and Delta-PostPP for PaO₂ /FiO₂ were linked to mortality of ICU [OR (95% CI) 0.48 (0.38, 0.59) and OR (95% CI) 0.60 (0.52, 0.68)]. Ventilatory ratio demonstrated a non-linear association with ICU mortality for Delta-PP (P = 0.022) and Delta-PostPP (P = 0.004). Delta-PP for Crs, but not Delta-PostPP, was linked with mortality of ICU [OR (95% CI) 0.80 (0.65, 0.98)]. A longer first cycle of prone positioning was inversely related to mortality [OR (95% CI) 0.82 (0.73, 0.91)]. Multivariable analysis revealed that the duration of the first cycle of prone positioning, Delta-PP and Delta-PostPP for PaO₂ /FiO₂, and ventilatory ratio was related to mortality.  

Investigators concluded that patients on mechanical ventilation with COVID-19 along acute respiratory failure who underwent prone positioning, the physiological response and duration of the initial prone position cycle were associated with ICU mortality. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01438-y