Early prone positioning in acute respiratory distress syndrome related to COVID-19: a propensity score analysis from the multicentric cohort COVID-ICU network—the ProneCOVID study
Authors: Le Terrier Christophe , Sigaud Florian , Lebbah Said , Desmedt Luc , Hajage David , Guérin Claude , Pugin Jérôme , Primmaz Steve , Terzi Nicolas ,   COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators, Mercat Alain , Asfar Pierre , Beloncle François , Demiselle Julien , Pham Tài , Pavot Arthur , Monnet Xavier , Richard Christian , Demoule Alexandre , Dres Martin , Mayaux Julien , Beurton Alexandra , Daubin Cédric , Descamps Richard , Joret Aurélie , Du Cheyron Damien , Pene Frédéric , Chiche Jean-Daniel , Jozwiak Mathieu , Jaubert Paul , Voiriot Guillaume , Fartoukh Muriel , Teulier Marion , Blayau Clarisse , L’Her Erwen , Aubron Cécile , Bodenes Laetitia , Ferriere Nicolas , Auchabie Johann , Le Meur Anthony , Pignal Sylvain , Mazzoni Thierry , Quenot Jean-Pierre , Andreu Pascal , Roudau Jean-Baptiste , Labruyère Marie , Nseir Saad , Preau Sébastien , Poissy Julien , Mathieu Daniel , Benhamida Sarah , Paulet Rémi , Roucaud Nicolas , Thyrault Martial , Daviet Florence , Hraiech Sami , Parzy Gabriel , Sylvestre Aude , Jochmans Sébastien , Bouilland Anne-Laure , Monchi Mehran , Déserts Marc Danguy des , Mathais Quentin , Rager Gwendoline , Pasquier Pierre , Jean Reignier , Amélie Seguin , Charlotte Garret , Emmanuel Canet , Dellamonica Jean , Saccheri Clément , Lombardi Romain , Kouchit Yanis , Jacquier Sophie , Mathonnet Armelle , Nay Mai-Ahn , Runge Isabelle , Martino Frédéric , Flurin Laure , Rolle Amélie , Carles Michel , Coudroy Rémi , Thille Arnaud W. , Frat Jean-Pierre , Rodriguez Maeva , Beuret Pascal , Tientcheu Audrey , Vincent Arthur , Michelin Florian , Tamion Fabienne , Carpentier Dorothée , Boyer Déborah , Girault Christophe , Gissot Valérie , Ehrmann Stéphan , Gandonniere Charlotte Salmon , Elaroussi Djlali , Delbove Agathe , Fedun Yannick , Huntzinger Julien , Lebas Eddy , Kisoka Grâce , Grégoire Céline , Marchetta Stella , Lambermont Bernard , Argaud Laurent , Baudry Thomas , Bertrand Pierre-Jean , Dargent Auguste , Guitton Christophe , Chudeau Nicolas , Landais Mickaël , Darreau Cédric , Ferre Alexis , Gros Antoine , Lacave Guillaume , Bruneel Fabrice , Neuville Mathilde , Devaquet Jérôme , Tachon Guillaume , Gallot Richard , Chelha Riad , Galbois Arnaud , Jallot Anne , Lemoine Ludivine Chalumeau , Kuteifan Khaldoun , Pointurier Valentin , Jandeaux Louise-Marie , Mootien Joy , Damoisel Charles , Sztrymf Benjamin , Schmidt Matthieu , Combes Alain , Chommeloux Juliette , Luyt Charles Edouard , Schortgen Frédérique , Rusel Leon , Jung Camille , Gobert Florent , Vimpere Damien , Lamhaut Lionel , Sauneuf Bertrand , Charrrier Liliane , Calus Julien , Desmeules Isabelle , Painvin Benoît , Tadie Jean-Marc , Castelain Vincent , Michard Baptiste , Herbrecht Jean-Etienne , Baldacini Mathieu , Weiss Nicolas , Demeret Sophie , Marois Clémence , Rohaut Benjamin , Moury Pierre-Henri , Savida Anne-Charlotte , Couadau Emmanuel , Série Mathieu , Alexandru Nica , Bruel Cédric , Fontaine Candice , Garrigou Sonia , Mahler Juliette Courtiade , Leclerc Maxime , Ramakers Michel , Garçon Pierre , Massou Nicole , Van Vong Ly , Sen Juliane , Lucas Nolwenn , Chemouni Franck , Stoclin Annabelle , Avenel Alexandre , Faure Henri , Gentilhomme Angélie , Ricome Sylvie , Abraham Paul , Monard Céline , Textoris Julien , Rimmele Thomas , Montini Florent , Lejour Gabriel , Lazard Thierry , Etienney Isabelle , Kerroumi Younes , Dupuis Claire , Bereiziat Marine , Coupez Elisabeth , Thouy François , Hoffmann Clément , Donat Nicolas , Chrisment Anne , Blot Rose-Marie , Kimmoun Antoine , Jacquot Audrey , Mattei Matthieu , Levy Bruno , Ravan Ramin , Dopeux Loïc , Liteaudon Jean-Mathias , Roux Delphine , Rey Brice , Anghel Radu , Schenesse Deborah , Gevrey Vincent , Castanera Jermy , Petua Philippe , Madeux Benjamin , Hartman Otto , Piagnerelli Michael , Joosten Anne , Noel Cinderella , Biston Patrick , Noel Thibaut , Bouar Gurvan L. E. , Boukhanza Messabi , Demarest Elsa , Bajolet Marie-France , Charrier Nathanaël , Quenet Audrey , Zylberfajn Cécile , Dufour Nicolas , Mégarbane Buno , Voicu Sqébastian , Deye Nicolas , Malissin Isabelle , Legay François , Debarre Matthieu , Barbarot Nicolas , Fillatre Pierre , Delord Bertrand , Laterrade Thomas , Saghi Tahar , Pujol Wilfried , Cungi Pierre Julien , Esnault Pierre , Cardinale Mickael , Ha Vivien Hong Tuan , Fleury Grégory , Brou Marie-Ange , Zafimahazo Daniel , Tran-Van David , Avargues Patrick , Carenco Lisa , Robin Nicolas , Ouali Alexandre , Houdou Lucie , Terrier Christophe Le , Suh Noémie , Primmaz Steve , Pugin Jérôme , Weiss Emmanuel , Gauss Tobias , Moyer Jean-Denis , Burtz Catherine Paugam , La Combe Béatrice , Smonig Rolland , Violleau Jade , Cailliez Pauline , Chelly Jonathan , Marchalot Antoine , Saladin Cécile , Bigot Christelle , Fayolle Pierre-Marie , Fatséas Jules , Ibrahim Amr , Resiere Dabor , Hage Rabih , Cholet Clémentine , Cantier Marie , Trouiler Pierre , Montravers Philippe , Lortat-Jacob Brice , Tanaka Sebastien , Dinh Alexy Tran , Duranteau Jacques , Harrois Anatole , Dubreuil Guillaume , Werner Marie , Godier Anne , Hamada Sophie , Zlotnik Diane , Nougue Hélène , Mekontso-Dessap Armand , Carteaux Guillaume , Razazi Keyvan , De Prost Nicolas , Mongardon Nicolas , Langeron Olivier , Levesque Eric , Attias Arié , de Roquetaillade Charles , Chousterman Benjamin G. , Mebazaa Alexandre , Gayat Etienne , Garnier Marc , Pardo Emmanuel , Satre-Buisson Lea , Gutton Christophe , Yvin Elise , Marcault Clémence , Azoulay Elie , Darmon Michael , Oufella Hafid Ait , Hariri Geoffroy , Urbina Tomas , Mazerand Sandie , Heming Nicholas , Santi Francesca , Moine Pierre , Annane Djillali , Bouglé Adrien , Omar Edris , Lancelot Aymeric , Begot Emmanuelle , Plantefeve Gaétan , Contou Damien , Mentec Hervé , Pajot Olivier , Faguer Stanislas , Cointault Olivier , Lavayssiere Laurence , Nogier Marie-Béatrice , Jamme Matthieu , Pichereau Claire , Hayon Jan , Outin Hervé , Dépret François , Coutrot Maxime , Chaussard Maité , Guillemet Lucie , Goffin Pierre , Thouny Romain , Guntz Julien , Jadot Laurent , Persichini Romain , Jean-Michel Vanessa , Georges Hugues , Caulier Thomas , Pradel Gaël , Hausermann Marie-Hélène , Nguyen-Valat Thi My Hue , Boudinaud Michel , Vivier Emmanuel , Rosseli Sylvène , Bourdin Gaël , Pommier Christian , Vinclair Marc , Poignant Simon , Mons Sandrine , Bougouin Wulfran , Bruna Franklin , Maestraggi Quentin , Roth Christian , Bitker Laurent , Dhelft François , Bonnet-Chateau Justine , Filippelli Mathilde , Morichau-Beauchant Tristan , Thierry Stéphane , Le Roy Charlotte , Jouan Mélanie Saint , Goncalves Bruno , Mazeraud Aurélien , Daniel Matthieu , Sharshar Tarek , Cadoz Cyril , Gaci Rostane , Gette Sébastien , Louis Guillaune , Sacleux Sophe-Caroline , Ordan Marie-Amélie , Cravoisy Aurélie , Conrad Marie , Courte Guilhem , Gibot Sébastien , Benzidi Younès , Casella Claudia , Serpin Laurent , Setti Jean-Lou , Besse Marie-Catherine , Bourreau Anna , Pillot Jérôme , Rivera Caroline , Vinclair Camille , Robaux Marie-Aline , Achino Chloé , Delignette Marie-Charlotte , Mazard Tessa , Aubrun Frédéric , Bouchet Bruno , Frérou Aurélien , Muller Laura , Quentin Charlotte , Degoul Samuel , Stihle Xavier , Sumian Claude , Bergero Nicoletta , Lanaspre Bernard , Quintard Hervé , Maiziere Eve Marie , Egreteau Pierre-Yves , Leloup Guillaume , Berteau Florin , Cottrel Marjolaine , Bouteloup Marie , Jeannot Matthieu , Blanc Quentin , Saison Julien , Geneau Isabelle , Grenot Romaric , Ouchike Abdel , Hazera Pascal , Masse Anne-Lyse , Demiri Suela , Vezinet Corinne , Baron Elodie , Benchetrit Deborah , Monsel Antoine , Trebbia Grégoire , Schaack Emmanuelle , Lepecq Raphaël , Bobet Mathieu , Vinsonneau Christophe , Dekeyser Thibault , Delforge Quentin , Rahmani Imen , Vivet Bérengère , Paillot Jonathan , Hierle Lucie , Chaignat Claire , Valette Sarah , Her Benoït , Brunet Jennifier , Page Mathieu , Boiste Fabienne , Collin Anthony , Bavozet Florent , Garin Aude , Dlala Mohamed , Mhamdi Kais , Beilouny Bassem , Lavalard Alexandra , Perez Severine , Veber Benoit , Guitard Pierre-Gildas , Gouin Philippe , Lamacz Anna , Plouvier Fabienne , Delaborde Bertrand P. , Kherchache Aïssa , Chaalal Amina , Ricard Jean-Damien , Amouretti Marc , Freita-Ramos Santiago , Roux Damien , Constantin Jean-Michel , Assefi Mona , Lecore Marine , Selves Agathe , Prevost Florian , Lamer Christian , Shi Ruiying , Knani Lyes , Floury Sébastien Pili , Vettoretti Lucie , Levy Michael , Marsac Lucile , Dauger Stéphane , Guilmin-Crépon Sophie , Winiszewski Hadrien , Piton Gael , Soumagne Thibaud , Capellier Gilles , Putegnat Jean-Baptiste , Bayle Frédérique , Perrou Maya , Thao Ghyslaine , Géri Guillaume , Charron Cyril , Repessé Xavier , Vieillard-Baron Antoine , Guilbart Mathieu , Roger Pierre-Alexandre , Hinard Sébastien , Macq Pierre-Yves , Chaulier Kevin , Goutte Sylvie , Chillet Patrick , Pitta Anaïs , Darjent Barbara , Bruneau Amandine , Lasocki Sigismond , Leger Maxime , Gergaud Soizic , Lemarie Pierre , Terzi Nicolas , Schwebel Carole , Dartevel Anaïs , Galerneau Louis-Marie , Diehl Jean-Luc , Hauw-Berlemont Caroline , Péron Nicolas , Guérot Emmanuel , Amoli Abolfazl Mohebbi , Benhamou Michel , Deyme Jean-Pierre , Andremont Olivier , Lena Diane , Cady Julien , Causeret Arnaud , De La Chapelle Arnaud , Cracco Christophe , Rouleau Stéphane , Schnell David , Foucault Camille , Lory Cécile , Chapelle Thibault , Bruckert Vincent , Garcia Julie , Sahraoui Abdlazize , Abbosh Nathalie , Bornstain Caroline , Pernet Pierre , Poirson Florent , Pasem Ahmed , Karoubi Philippe , Poupinel Virginie , Gauthier Caroline , Bouniol François , Feuchere Philippe , Bavozet Florent , Heron Anne , Carreira Serge , Emery Malo , Le Floch Anne Sophie , Giovannangeli Luana , Herzog Nicolas , Giacardi Christophe , Baudic Thibaut , Thill Chloé , Lebbah Said , Palmyre Jessica , Tubach Florence , Hajage David , Bonnet Nicolas , Ebstein Nathan , Gaudry Stéphane , Cohen Yves , Noublanche Julie , Lesieur Olivier , Sément Arnaud , Roca-Cerezo Isabel , Pascal Michel , Sma Nesrine , Colin Gwenhaël , Lacherade Jean-Claude , Bionz Gauthier , Maquigneau Natacha , Bouzat Pierre , Durand Michel , Hérault Marie-Christine , Payen Jean-Francois 
Published: March 2022

Abstract
Background
Delaying time to prone positioning (PP) may be associated with higher mortality in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). We evaluated the use and the impact of early PP on clinical outcomes in intubated patients hospitalized in intensive care units (ICUs) for COVID-19.

Methods
All intubated patients with ARDS due to COVID-19 were involved in a secondary analysis from a prospective multicenter cohort study of COVID-ICU network including 149 ICUs across France, Belgium and Switzerland. Patients were followed-up until Day-90. The primary outcome was survival at Day-60. Analysis used a Cox proportional hazard model including a propensity score.

Results
Among 2137 intubated patients, 1504 (70.4%) were placed in PP during their ICU stay and 491 (23%) during the first 24 h following ICU admission. One hundred and eighty-one patients (36.9%) of the early PP group had a PaO2/FiO2 ratio > 150 mmHg when prone positioning was initiated. Among non-early PP group patients, 1013 (47.4%) patients had finally been placed in PP within a median delay of 3 days after ICU admission. Day-60 mortality in non-early PP group was 34.2% versus 39.3% in the early PP group (p = 0.038). Day-28 and Day-90 mortality as well as the need for adjunctive therapies was more important in patients with early PP. After propensity score adjustment, no significant difference in survival at Day-60 was found between the two study groups (HR 1.34 [0.96–1.68], p = 0.09 and HR 1.19 [0.998–1.412], p = 0.053 in complete case analysis or in multiple imputation analysis, respectively).

Conclusions
In a large multicentric international cohort of intubated ICU patients with ARDS due to COVID-19, PP has been used frequently as a main treatment. In this study, our data failed to show a survival benefit associated with early PP started within 24 h after ICU admission compared to PP after day-1 for all COVID-19 patients requiring invasive mechanical ventilation regardless of their severity.