Zheng Yuwei, Chen Chaochao, Bi Xiaojie, Li Xiaowei, Wang Jing, Zheng Yufen, Yuan Yuan, Jiang Yongpo, Shen Bo, Xu Yinghe
Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, People's Republic of China.
Department of Pathology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, People's Republic of China.
Int J Gen Med. 2025 Sep 11;18:5367-5377. doi: 10.2147/IJGM.S543206. eCollection 2025.
The role of prone position (PP) in critically ill patients diagnosed with coronavirus disease 2019 (COVID-19) undergoing invasive mechanical ventilation remains unclear. This study aimed to evaluate the potential prognostic benefits of PP.
This retrospective study included data from 289 critically ill patients with COVID-19 who underwent invasive mechanical ventilation in a multicenter setting. Propensity score matching was used to match 156 patients (78 PP-treated, 78 non-PP-treated) after adjusting for age, sex, underlying disease, and Sequential Organ Failure Assessment score. Between-group comparisons of clinical data, laboratory results, and prognosis were performed. Kaplan-Meier (K-M) survival curve and univariate and multivariate Cox regression analyses were used to explore the relationship between PP and prognosis.
Prone positioning improved oxygenation (oxygenation index in the PP group increased consistently, with the greatest improvement observed on days 12-13 compared with the non-PP group [48 vs 32 mmHg; P < 0.001]) and increased hospital survival (80.8% vs 65.4%; P = 0.047). K-M survival curve analysis revealed that patients treated with PP had a more favorable prognosis (P = 0.025). Multivariate Cox regression revealed that PP was linked to lower risk of death (HR 0.389 [95% CI 0.173-0.878]), while age (HR 1.053 [95% CI 1.012-1.096]), Acute Physiology and Chronic Health Evaluation II score (HR 1.055 [95% CI 1.006-1.107]), and troponin T levels (HR 2.028 [95% CI 1.222-3.367]) were linked to higher risk of death in the overall survival of patients with COVID-19.
PP improved oxygenation and increased the survival rate of critically ill patients with COVID-19 undergoing invasive mechanical ventilation. Adopting PP as much as possible during nursing care may enhance patient survival.
俯卧位（PP）在接受有创机械通气的2019冠状病毒病（COVID-19）重症患者中的作用仍不明确。本研究旨在评估PP的潜在预后益处。
这项回顾性研究纳入了多中心环境下289例接受有创机械通气的COVID-19重症患者的数据。在调整年龄、性别、基础疾病和序贯器官衰竭评估评分后，采用倾向评分匹配法匹配了156例患者（78例接受PP治疗，78例未接受PP治疗）。对临床数据、实验室结果和预后进行组间比较。采用Kaplan-Meier（K-M）生存曲线以及单因素和多因素Cox回归分析来探讨PP与预后之间的关系。
俯卧位改善了氧合（PP组的氧合指数持续增加，与非PP组相比，在第12 - 13天改善最为明显[48 vs 32 mmHg；P < 0.001]），并提高了住院生存率（80.8% vs 65.4%；P = 0.047）。K-M生存曲线分析显示，接受PP治疗的患者预后更有利（P = 0.025）。多因素Cox回归显示，PP与较低的死亡风险相关（HR 0.389 [95% CI 0.173 - 0.878]），而年龄（HR 1.053 [95% CI 1.012 - 1.096]）、急性生理与慢性健康状况评估II评分（HR 1.055 [95% CI 1.006 - 1.107]）和肌钙蛋白T水平（HR 2.028 [95% CI 1.222 - 3.367]）与COVID-19患者总体生存中的较高死亡风险相关。
PP改善了氧合，并提高了接受有创机械通气的COVID-19重症患者的生存率。在护理过程中尽可能采用PP可能会提高患者的生存率。
