Influence of Prone Position on the Survival of COVID-19 Patients Undergoing Invasive Mechanical Ventilation: A Propensity Score Matching Study

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.