• Nicolò Sella, Tommaso Pettenuzzo, Sabrina Congedi, Maria Bisi, Giulio Gianino, Agnese De Carolis, Carlo Alberto Bertoncello, Mario Roccaforte, Francesco Zarantonello, Paolo Persona, Enrico Petranzan, Gabriella Roca, Eugenio Biamonte, Michele Carron, Andrea Dell'Amore, Federico Rea, Annalisa Boscolo, and Paolo Navalesi.
• Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy.
• J. Cardiothorac. Vasc. Anesth. 2024 Nov 26.

ObjectivesPrimary graft dysfunction (PGD) affects survival after lung transplant (LT). The current hypothesis was that prone positioning (PP), proposed as a rescue maneuver to treat refractory hypoxemia due to PGD, may improve LT outcomes, especially when applied early.DesignBilateral LT recipients developing moderate-to-severe PGD within 24 hours from intensive care unit admission were enrolled. From January 2020 to November 2021, patients developing PGD after LT were turned prone between 24 and 48 hours after diagnosis, only in case of radiological or oxygenation worsening ("late PP" group). After November 2021, patients were routinely turned prone within 24 hours from PGD diagnosis ("early PP"). A propensity score-weighted analysis, adjusted for clinically relevant covariates, was applied.SettingIntensive care unit.ParticipantsBilateral LT recipients.InterventionsEarly PP, late PP, or supine position.Measurements And Main Results130 LT patients were screened and 67 were enrolled. A total of 25 (37%) recipients were treated in the supine position, 24 (36%) in early PP, and 18 (27%) in late PP. After propensity score weighting, both supine treatment (estimated effect for 1 ventilator-free day = 8.23, standard error: 2.97, p = 0.007) and early PP treatment (estimated effect = 9.42, standard error: 2.59, p < 0.001) were associated with greater 28-day ventilator-free days than late PP treatment (reference). Compared with late PP, early PP was also associated with better oxygenation, driving pressure, and static respiratory system compliance. Compared with supine recipients, the early PP group showed better oxygenation at 72 hours after PGD diagnosis.ConclusionsEarly PP in LT recipients with moderate-to-severe PGD seems to be associated with better 28-day ventilator-free days, oxygenation, and driving pressure than late PP.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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