Evidence map›Paper›PMID 32839769›Full record

ArticleResearch square2020

Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome due to COVID-19: A Cohort Study and Analysis of Physiology.

Mehdi Shelhamer, Paul D Wesson, Ian L Solari, Deanna L Jensen, William Alex Steele, Vihren G Dimitrov, John Daniel Kelly, Shazia Aziz, Victor Perez Gutierrez, Eric Vittinghoff and 4 more

Open access · greenAbstract readPreprint
PubMed Full text at PMC Publisher
In one paragraph

Article in Research square, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 23 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 4 institutions in 1 country.

Mehdi ShelhamerNYC Health and Hospitals Lincoln.ORCID 0000-0003-4374-7377
Paul D WessonUniversity of California San Francisco.
Ian L SolariUS Air Force Medical Service.
Deanna L JensenUS Air Force Medical Service.
William Alex SteeleUS Air Force Medical Service.
Vihren G DimitrovNYC Health and Hospitals Lincoln.
John Daniel KellyUniversity of California San Francisco.
Shazia AzizNYC Health and Hospitals Lincoln.
Victor Perez GutierrezNYC Health and Hospitals Lincoln.
Eric VittinghoffUniversity of California San Francisco.
Kevin K ChungUniformed Services University of the Health Sciences F Edward Hebert School of Medicine.
Vidya P MenonNYC Health and Hospitals Lincoln.
Herman A AmbrisNYC Health and Hospitals Lincoln.
Sanjiv M BaxiUniversity of California San Francisco.
New York City Health and Hospitals Corporation · USUniversity of California, San Francisco · USUnited States Air Force · USUniformed Services University of the Health Sciences · US

Funding

Ebola modeling: behavior, asymptomatic infection, and contacts (2019-nCoV Admin Supplement)R01GM130900 · NIGMS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI PORCO, TRAVIS CHRISTIAN · 2019 to 2022
$1.6M
The science for the last mile: Enhanced epidemiologic surveillance to accelerate HIV eliminationK01AI145572 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI WESSON, PAUL DOUGLAS · 2020 to 2024
$679k
NIAID NIH HHS K01 AI145572NIGMS NIH HHS R01 GM130900
6 · The paper itself

Abstract

backgroundCoronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS) but it is unknown whether prone positioning improves outcomes in mechanically ventilated patients with moderate to severe ARDS due to COVID-19.

methodsA cohort study at a New York City hospital at the peak of the early pandemic in the United States, under crisis conditions. The aim was to determine the benefit of prone positioning in mechanically ventilated patients with ARDS due to COVID-19. The primary outcome was in-hospital death. Secondary outcomes included changes in physiologic parameters. Fine-Gray competing risks models with stabilized inverse probability treatment weighting (sIPTW) were used to determine the effect of prone positioning on outcomes. In addition, linear mixed effects models (LMM) were used to assess changes in physiology with prone positioning.

resultsOut of 335 participants who were intubated and mechanically ventilated, 62 underwent prone positioning, 199 met prone positioning criteria and served as controls and 74 were excluded. The intervention and control groups were similar at baseline. In multivariate-adjusted competing risks models with sIPTW, prone positioning was significantly associated with reduced mortality (SHR 0.61, 95% CI 0.46-0.80,

conclusionsProne positioning in patients with moderate to severe ARDS due to COVID-19 is associated with reduced mortality and improved physiologic parameters. One in-hospital death could be averted for every eight patients treated. Replicating results and scaling the intervention are important, but prone positioning may represented an additional therapeutic option in patients with ARDS due to COVID-19.

Identifiers

PMID32839769
PMCPMC7444300
OpenAlexW3081141330

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.