Observational studyCritical care medicine2026
Prone Positioning in a North American Cohort of Hypoxemic Patients on Mechanical Ventilation.
Observational study in Critical care medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The trial behind it
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Who cites it
1 citing paper in PubMed.
- Prone Positioning in a North American Cohort of Hypoxemic Patients on Mechanical Ventilation.Critical care medicine · 2026Observational
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22 authors.
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Abstract
objectivesDespite historically limited adoption of prone positioning, a potentially life-saving guideline-recommended intervention for moderate-severe acute respiratory distress syndrome, its use increased for mechanically ventilated patients during the COVID-19 pandemic. Whether implementation of this guideline-recommended intervention was sustained is unknown. Thus, we aimed to evaluate peri-pandemic trends in proning use.
designWe conducted a retrospective cohort study of proning use among mechanically ventilated adults compared across pre-pandemic (from January 2018 to February 2020), pandemic (from March 2020 to February 2022), and post-pandemic (from March 2022 to December 2024) periods.
settingThirty-seven North American hospitals. PATIENTS: Mechanically ventilated patients with persistent moderate-to-severe hypoxemia (Pa o2 /F io2 ≤ 150 mm Hg, F io2 ≥ 0.6, and positive end-expiratory pressure ≥ 5 cm H 2 O).
interventionsProning within 12 hours of meeting hypoxemia criteria. MEASUREMENTS AND MAIN
resultsAmong 5944 proning-eligible patients, 2155 (36.2%) received proning: 11.0% pre-pandemic, 51.9% pandemic, and 25.6% post-pandemic. The adjusted odds ratio (OR) for proning during the pandemic vs. pre-pandemic periods was 7.6 (95% CI, 5.5-10.4), and during the pandemic vs. post-pandemic periods was 2.7 (95% CI, 1.8-3.9). Proning varied widely by hospital and was quantified with median ORs (median change in odds of proning for similar patients admitted at a lower vs. higher proning hospital) of 2.9 (95% credible interval [CrI], 1.9-5.3) pre-pandemic, 1.9 (95% CrI, 1.6-2.3) pandemic, and 2.3 (95% CrI, 1.8-3.3) post-pandemic. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive vs. negative pandemic-period patients had increased proning use (OR, 5.1; 95% CI, 4.1-5.6), as did pandemic-period patients without SARS-CoV-2 compared with pre-pandemic patients (OR, 3.8; 95% CI, 2.7-5.2). The difference in proning use between pandemic SARS-CoV-2 negative and post-pandemic patients was smaller and not significant (OR, 1.3; 95% CI, 0.9-1.8).
conclusionsIn a North American cohort of proning-eligible patients, proning increased during the pandemic and then declined. Interventions that improve and sustain implementation of this guideline-recommended intervention are needed.
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