Critical care (London, England) · 2026
Elastance as a determinant of the effect of prone positioning on mortality in acute respiratory distress syndrome: a post hoc analysis of the PROSEVA trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Zalucky Ann A, Goligher Ewan C, Dianti Jose, Willmore Andrew, Guerin Claude, Calfee Carolyn S
Аннотация
BACKGROUND: Patient factors determining the benefit of prone positioning remain uncertain, resulting in the maneuver being applied indiscriminately among those with moderate-severe ARDS. We aimed to assess if baseline respiratory system elastance (Ers), or "stiffness", determines the treatment effect of prone positioning on mortality.
METHODS: Bayesian logistic regression modeling of the PROSEVA Trial was used to estimate the posterior probability of prone positioning effect moderation by baseline Ers on 90-day mortality in patients with moderate-severe ARDS. As a secondary aim, we tested whether the absolute change in driving pressure of the respiratory system (∆DPrs ) in response to prone positioning predicted 90-day mortality, using logistic regression.
RESULTS: The treatment effect of prone positioning on mortality did not meaningfully vary with baseline Ers (posterior probability of benefit OR < 0.95 = 52%; interaction OR 0.94, 90% credible interval, CrI, 0.74-1.20). Higher baseline Ers was associated with greater improvements in DPrs at the end of the first prone session (β= -3.3, 95% confidence interval (CI) -4.09, -2.49; p = < 0.001). However, this response was not associated with mortality benefit in adjusted models (OR 1.14, 95% CI 0.96, 1.37; p = 0.14).
CONCLUSIONS: The effect of prone positioning on mortality did not vary with Ers in the PROSEVA trial. Similarly, prone positioning-induced improvement in DPrs was not predictive of mortality in this cohort of passively ventilated ARDS patients.
METHODS: Bayesian logistic regression modeling of the PROSEVA Trial was used to estimate the posterior probability of prone positioning effect moderation by baseline Ers on 90-day mortality in patients with moderate-severe ARDS. As a secondary aim, we tested whether the absolute change in driving pressure of the respiratory system (∆DPrs ) in response to prone positioning predicted 90-day mortality, using logistic regression.
RESULTS: The treatment effect of prone positioning on mortality did not meaningfully vary with baseline Ers (posterior probability of benefit OR < 0.95 = 52%; interaction OR 0.94, 90% credible interval, CrI, 0.74-1.20). Higher baseline Ers was associated with greater improvements in DPrs at the end of the first prone session (β= -3.3, 95% confidence interval (CI) -4.09, -2.49; p = < 0.001). However, this response was not associated with mortality benefit in adjusted models (OR 1.14, 95% CI 0.96, 1.37; p = 0.14).
CONCLUSIONS: The effect of prone positioning on mortality did not vary with Ers in the PROSEVA trial. Similarly, prone positioning-induced improvement in DPrs was not predictive of mortality in this cohort of passively ventilated ARDS patients.