Impact of proning with and without inhaled pulmonary vasodilators and neuromuscular blocking agents in COVID acute respiratory distress syndrome

doi:10.5492/wjccm.v14.i3.101327

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World Journal of Critical Care Medicine

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2220-3141

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Crit Care Med. Sep 9, 2025; 14(3): 101327
Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.101327

Table 2 Clinical features, baseline ventilator settings and hard outcomes of patients that received either intervention in combination with prone position ventilation compared to controls, n (%)

Characteristic	All	Control	Prone position ventilation ± rescue therapy	P value
n	114	25	89	-
Highest Sequential Organ Failure Assessment score (mean ± SD)	13.8 ± 3.2	11.7 ± 3.5	14.4 ± 2.9	< 0.001^a
Baseline respiratory parameters (mean ± SD)
FiO₂	73.6 ± 21.4	55 ± 15.6	80.2 ± 19.2	< 0.001^a
PaO₂	85.9 ± 35.0	105.7 ± 45.7	80.3 ± 29.2	0.002^a
PaO₂/FiO₂	121.6 ± 58.8	175.7 ± 75.0	105.3 ± 41.4	< 0.001^a
SpO₂	94.8 ± 4.5	97.2 ± 3.5	94.0 ± 4.5	0.001^a
Baseline ventilator parameters, median (interquartile range)
Positive end expiratory pressure (cm H₂O)	11.1 ± 6.3	10.8 ± 7.9	11.2 ± 4.9	0.771
Tidal volume (mL)	425.7 ± 64.8	418.4 ± 65.6	429.2 ± 64.8	0.496
Plateau pressure (cm H₂O)	25.2 ± 5.5	24.3 ± 6.1	25.6 ± 5.1	0.360
Driving pressure (cm H₂O)	14.6 ± 4.4	15.2 ± 4.8	14.3 ± 4.2	0.470
Tidal compliance (mL/cm H₂O)	32.4 ± 10.1	31.0 ± 9.0	33.1 ± 10.6	0.478
Peak inspiratory pressure (cm H₂O)	31.0 ± 7.3	28.0 ± 6.1	32.6 ± 7.4	0.009^a
O₂ index	14.0 ± 9.0	9.7 ± 11.2	16.4 ± 6.6	0.002^a
Average number of times patient was proned during hospitalization	-	-	1.3	-
Average time from intubation to first prone (hours)	-	-	25.7	-
Average duration of first proning session (days) (n = 89)	-	-	2.5	-
Average duration of second proning session (days) (n = 44)	-	-	2.6	-
Average duration of third proning session (days) (n = 12)	-	-	1.5	-
Primary outcomes
Mortality	59 (50.8)	12 (48.0)	47 (51.65)	0.747
Venovenous extracorporeal membrane oxygenation	21.9 (25)	8 (2.0)	76 (19)	0.052^a
Intensive care unit LOS (mean ± SD)	15.2 ± 12.8	7.4 ± 7.0	17.3 ± 13.2	< 0.001^a
Hospital LOS (mean ± SD)	20.2 ± 15.7	12.6 ± 14.1	22.3 ± 15.6	0.003^a

^aStatistically significant value (P < 0.05).

FiO₂: Fractional inspired oxygen; LOS: Length of stay; PaO_2: Arterial oxygen partial pressure.

Citation: Cabrera M, Bharil S, Chin M, Yohannes S, Clark P. Impact of proning with and without inhaled pulmonary vasodilators and neuromuscular blocking agents in COVID acute respiratory distress syndrome. World J Crit Care Med 2025; 14(3): 101327
URL: https://www.wjgnet.com/2220-3141/full/v14/i3/101327.htm
DOI: https://dx.doi.org/10.5492/wjccm.v14.i3.101327