{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T16:11:03Z","timestamp":1783959063990,"version":"3.55.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Despite 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>We 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Thirty-seven North American hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>\n                      Mechanically ventilated patients with persistent moderate-to-severe hypoxemia (Pa\n                      <jats:sc>o<\/jats:sc>\n                      <jats:sub>2<\/jats:sub>\n                      \/F\n                      <jats:sc>io<\/jats:sc>\n                      <jats:sub>2<\/jats:sub>\n                      \u2264 150\u2009mm Hg, F\n                      <jats:sc>io<\/jats:sc>\n                      <jats:sub>2<\/jats:sub>\n                      \u2265 0.6, and positive end-expiratory pressure \u2265 5\u2009cm H\n                      <jats:sub>2<\/jats:sub>\n                      O).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions:<\/jats:title>\n                    <jats:p>Proning within 12 hours of meeting hypoxemia criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results:<\/jats:title>\n                    <jats:p>Among 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\u201310.4), and during the pandemic vs. post-pandemic periods was 2.7 (95% CI, 1.8\u20133.9). 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\u20135.3) pre-pandemic, 1.9 (95% CrI, 1.6\u20132.3) pandemic, and 2.3 (95% CrI, 1.8\u20133.3) 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\u20135.6), as did pandemic-period patients without SARS-CoV-2 compared with pre-pandemic patients (OR, 3.8; 95% CI, 2.7\u20135.2). 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\u20131.8).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/ccm.0000000000007148","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T14:00:08Z","timestamp":1779458408000},"page":"1597-1609","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Prone Positioning in a North American Cohort of Hypoxemic Patients on Mechanical Ventilation"],"prefix":"10.1097","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0719-6838","authenticated-orcid":false,"given":"Anna K.","family":"Barker","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiko","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Nuppnau","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin G.","family":"Buell","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care, University of Chicago, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick G.","family":"Lyons","sequence":"additional","affiliation":[{"name":"Department of Medicine, Oregon Health and Science University, Portland, OR."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan-Ting","family":"Liao","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenna","family":"Park-Egan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Oregon Health and Science University, Portland, OR."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin E.","family":"Schmid","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas E.","family":"Ingraham","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaishvik","family":"Chaudhari","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Critical Care, and Sleep Medicine, Rush University, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine A.","family":"Gao","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander C.","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA."},{"name":"Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary E.","family":"Weissman","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA."},{"name":"Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaveri","family":"Chhikara","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care, University of Chicago, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C.","family":"Rojas","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Critical Care, and Sleep Medicine, Rush University, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre C. K. B.","family":"Amaral","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada."},{"name":"Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William F.","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care, University of Chicago, Chicago, IL."},{"name":"MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore J.","family":"Iwashyna","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD."},{"name":"Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David N.","family":"Hager","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Sjoding","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4376-5754","authenticated-orcid":false,"given":"Chad H.","family":"Hochberg","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Common Longitudinal ICU data Format (CLIF) Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"R1-20260713","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1001\/jama.2016.0291","article-title":"Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries.","volume":"315","author":"Bellani","year":"2016","journal-title":"JAMA"},{"key":"R2-20260713","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1164\/rccm.201806-1094OC","article-title":"Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome. 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