Evidence map›Paper›PMID 41484689›Full record

ArticleJournal of anesthesia, analgesia and critical care2026

Time-dependent effects in consecutive cycles of prone positioning for acute respiratory failure: insights from the PROVENT-C19 Registry.

Nicolò Sella, Annalisa Boscolo, Andrea Cortegiani, Giacomo Bellani, Giuseppe Foti, Silvia De Rosa, Annalisa Pitino, Giovanni Luigi Tripepi, Lucia Cattin, Alessandro De Cassai and 15 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of anesthesia, analgesia and critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–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

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Comment on PROVENT-C19 repeated prone positioning analysis.Journal of anesthesia, analgesia and critical care · 2026
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

25 authors.

Nicolò Sella *Department of Medicine (DIMED), University of Padova, Padova, PD, Italy.
Annalisa Boscolo *Department of Medicine (DIMED), University of Padova, Padova, PD, Italy.
Andrea CortegianiDepartment of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy.
Giacomo BellaniCentre for Medical Sciences-CISMed, University of Trento, Trento, Italy.
Giuseppe FotiDepartment of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
Silvia De RosaCentre for Medical Sciences-CISMed, University of Trento, Trento, Italy.
Annalisa PitinoCNR-IFC, Institute of Clinical Physiology of Roma, Roma, Italy.
Giovanni Luigi TripepiCNR-IFC, Institute of Clinical Physiology of Reggio Calabria, Reggio Calabria, Italy.
Lucia CattinUOC Anestesia e Rianimazione, AULSS8 Berica, Ospedale San Bortolo, Vicenza, Italy.
Alessandro De CassaiDepartment of Medicine (DIMED), University of Padova, Padova, PD, Italy.
Muhammed ElhadiFaculty of Medicine, University of Tripoli, Tripoli, Libya.
Giorgio FullinAnesthesia and Intensive Care, Ospedale all'Angelo, Mestre, Italy.
Eugenio GarofaloAnaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.
Leonardo GottinUOC di Anestesia e Terapia Intensiva Cardio-Toraco-Vascolare, Dipartimento di Emergenza e Terapie Intensive, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
Alberto GrassettoUOC Anestesia e Rianimazione, Ospedale di Vittorio Veneto, Vittorio Veneto (TV), Italy.
Salvatore Maurizio MaggioreUniversity Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy.
Elena MomessoAnaesthesia and Intensive Care Unit, Ospedali di San Donà di Piave e Jesolo, San Donà di Piave, Italy.
Mario PetaDepartment of Anesthesia and Intensive Care, Santa Maria dei Battuti-Ca' Foncello Hospital, Treviso, Italy.
Tommaso PettenuzzoDepartment of Medicine (DIMED), University of Padova, Padova, PD, Italy.
Daniele PooleAnesthesia and Critical Care Unit, Ospedale di Belluno, Belluno, Italy.
Roberto RonaDepartment of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
Andrea ZanolettiAnesthesia and Intensive Care Unit, Manerbio Hospital, Manerbio, Italy.
Emanuele Rezoagli *Department of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
Paolo Navalesi *Department of Medicine (DIMED), University of Padova, Padova, PD, Italy. paolo.navalesi@unipd.it.
SIAARTI Study Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundProne positioning is recommended for patients with acute respiratory distress syndrome not only to improve oxygenation, but also to reduce lung stress, and lower mortality. The association between improved oxygenation during prone position and reduced mortality is still controversial. In previous studies, oxygenation improvement during the first prone positioning cycle was linked to lower intensive care unit (ICU) mortality, especially with prolonged duration. However, physiological data during subsequent cycles were lacking. This study aims to explore the association between ICU mortality and physiological responses to prone positioning-such as arterial oxygenation, dead space, and respiratory mechanics-and to assess how the cumulative time spent in prone or supine positions across all studied cycles influences outcomes.

methodsInternational registry including adult patients who underwent prone positioning for acute hypoxemic respiratory failure due to COVID-19. We measured the difference for arterial partial pressure of oxygen to inspired fraction of oxygen ratio (PaO2/FiO2) and ventilatory ratio between baseline supine position and at either the end of cycle of prone position (Delta-PP) or re-supination (Delta-PostPP), focusing on the cycles following the first one.

resultsWe included 1523 patients from 53 centers. Both Delta-PP and Delta-PostPP for PaO2/FiO2 were significantly higher in ICU survivors than in ICU non-survivors for all the analyzed prone positioning cycles (p ≤ 0.001 for all comparisons). Delta-PP and Delta-PostPP for ventilatory ratio were significantly lower in ICU survivors than in ICU non-survivors for all the analyzed prone positioning cycles (p < 0.05 for all comparisons). No difference in the overall time spent in prone position was found between ICU survivors and non-survivors [61 (38, 84) h vs 58 (32, 85) h, respectively, p = 0.175]. The cumulative length of prone position was associated with ICU mortality only for the second prone positioning cycle [OR (95% CI) 0.986 (0.978, 0.994)]. No significant association was observed between the time spent in supine position and ICU mortality for all the analyzed prone positioning cycles.

conclusionsICU survivors consistently demonstrated better oxygenation and more stable ventilatory ratio across studied prone positioning cycles, whereas non-survivors showed worsening oxygenation when returning supine and increased ventilatory ratio. Additionally, extending the duration of prone position beyond the second cycle may not significantly impact mortality.

Indexed as

Acute respiratory failureArterial oxygenationDriving pressureMechanical ventilationProne positionVentilatory ratio

Identifiers

PMID41484689
PMCPMC12866320

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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.