Effect of Prone Position in Severe Covid-19 Patients in a Referral Center: A Cohort Retrospective Study

Introduction: Covid-19 is defined as a pandemic disease by WHO, in November 2023, WHO recorded 772.1 million confirmed cases and 6.9 million deaths, including 68,382 confirmed cases and 1426 deaths in Madagascar. The management of severe cases of Covid-19 remains a challenge for the healthcare system in a resource-limited country, due to the consumption of human resources, the shortage of medical resources and the lack of capacity in resource-limited countries. Prone position (PP) improves survival in acute respiratory distress, and numerous studies have shown that during Covid-19, it reduces mortality rates at 28 and 90 days, and increases the number of days without mechanical ventilation. However, data on the beneficial effects of PP remain limited in low-income countries. In this context, our study aims to evaluate the benefits of the prone position for severe Covid-19 patients in a referral center in Madagascar. Method: This is a retrospective cohort study, during the 2nd and 3rd waves of COVID-19, over a period of 11 months in two wards managing COVID-19 cases. We included all patients aged 15 and over with severe forms of COVID-19 who required 6 l/min of oxygen therapy. Results: We enrolled 123 patients, including 40 in the prone position and 83 in the supine position, with a mean age of 60.5 ± 12 years. The prone position (DV) reduced the risk of probable complications of COVID-19 with a strong association in terms of use of respiratory assistance (OR = 0.15;95% CI = 0.05 - 0.47), respiratory deterioration (OR = 0.22;95% CI = 0.09 - 0.58), shock (OR = 0.30;95% CI = 0.11 - 0.79) and hemodynamic instability (OR = 0.33;95% CI = 0.12 - 0.95). Univariate analysis of the effect of prone position on SpO2 showed improvement with significant associations with SpO2 at Day 1- Day 3, D4 - D7, D8 - D14, and persisting even at D15 - D21, D3 and D2 before discharge, and at discharge. In the overall population, the mean length of hospital stay was 22.8 ± 22.1 days, with extremes of 1 and 67 days. Univariate analysis of the effect of the prone position showed a reduction in length of hospital stay with a strong association (p = 0.001) and a mean difference of 14 days. The prone position reduced mortality with a significant association (OR = 0.44;95% CI = 0.20 - 0.98). Conclusion: Awake prone position prevents complications of COVID, improves SPO2 even up to hospital discharge and reduces hospital stay. This practice is simple, less costly and suitable in low income countries.

Advances in the Use of Prone Cardiopulmonary Resuscitation During Spinal Surgery in the Prone Position

Spinal surgery is usually performed in the prone position, which is a longer and more difficult procedure and is prone to complications such as circulatory dysfunction and stress injuries. Among them, stress injury is the main complication of prone spine surgery, but the reasons for stress injury in prone spine surgery are not clear, and whether prone cardiopulmonary resuscitation (CPR) can be used needs to be further verified. Supine cardiopulmonary resuscitation is commonly used in posterior spinal surgery, retroperitoneal surgery, and so on, which can effectively improve the patient’s hypoxemia. Such surgeries require a high level of anesthetic management, and cardiopulmonary resuscitation is necessary if a patient in a prone position experiences cardiac arrest. In the process of cardiopulmonary resuscitation, supine cardiopulmonary resuscitation is often used, especially for some obese patients, if they are immediately changed to the supine position, it takes up more time, there may be wound infection, and there is a possibility of missing the optimal rescue and resuscitation time. Based on this, this paper reviews the use of prone-position cardiopulmonary resuscitation for spinal surgery in the prone position.

Clinical Nursing for Patients Undergoing Prone-Position Laparoscopic Partial Nephrectomy

Objective:To explore effective nursing strategies for patients undergoing prone-position laparoscopic partial nephrectomy.Methods:A total of 19 patients undergoing prone-position laparoscopic partial nephrectomy were selected,with hospital admission spanning from January 2024 to June 2024.Patients were randomly divided into the study group(n=10)and the control group(n=9).The control group received basic nursing care,while the study group received comprehensive high-quality nursing care.The recovery period,length of hospital stay,complication rates,SCL-90 scores,and nursing quality scores were compared between the two groups.Results:The recovery period and hospital stay were significantly shorter in the study group compared to the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).After the nursing intervention,the SCL-90 scores of the study group were lower than those of the control group(P<0.05).Nursing quality scores were higher in the study group than in the control group(P<0.05).Conclusion:Comprehensive high-quality nursing intervention for patients undergoing prone-position laparoscopic partial nephrectomy can shorten the recovery period and hospital stay,reduce the complication rate,improve mental health,and enhance nursing quality,making it suitable for wider application in medical institutions.

Effects of the prone position on arterial blood gas analysis and respiratory parameters of acute respiratory distress syndrome patients:An observational retrospective study

Objective:To investigate the effect of the first prone position on arterial blood gas analysis and respiratory parameters of acute respiratory distress syndrome(ARDS)patients with and without COVID.Methods:This study was conducted retrospectively with 22 COVID-ARDS and 22 non-COVID ARDS patients,who were placed in a prone position for at least 16 hours on the first day at the intensive care unit admission,and arterial blood gas analysis was taken in the pre-prone,prone and post-prone periods.Results:PaO2 were significantly increased in the pre-prone vs.prone comparison in both groups,but the increase in the PaO2/FiO2 ratio was not significant.In comparing the pre-prone vs.post-prone PaO2/FiO2 ratios,there was a significant difference only in the non-COVID ARDS group.Conclusions:The improved oxygenation provided by prone positioning is more permanent with the“post-prone effect”in non-COVID ARDS patients.This can be attributed to the differences in the pathogenesis of the two ARDS types.

Rigid ureteroscopy in prone split-leg position for fragmentation of female ureteral stones:A case report

BACKGROUND Ureteroscopy is widely used in the treatment of ureteral stones due to the increased morbidity of turolithiasis.This is the first report of a case of ureteral calculi treated with rigid ureteroscopy in the modified prone split-leg position.CASE SUMMARY A 62-year-old Asian woman was diagnosed with a ureteral stone and underwent extracorporeal shock wave lithotripsy twice.However,the abdominal computer tomography scan showed persistent calculi on the right lower ureter.Her left hip movement was limited because of a left femoral neck fracture that did not receive proper treatment in a timely manner.She was unable to undergo surgery in the lithotomy position and refused to accept flexible ureteroscopy treatment.Therefore,rigid ureteroscopy was performed with her in the modified prone split-leg position.The ureteral calculi were successfully fragmented.CONCLUSION It is feasible to treat lower ureteral calculi in women in the prone split-leg position with the implementation of rigid ureteroscopy.

Complications associated with prone positioning in elective spinal surgery

Complications associated with prone surgical positioning during elective spine surgery have the potential to cause serious patient morbidity.Although many ofthese complications remain uncommon,the range of possible morbidities is wide and includes multiple organ systems.Perioperative visual loss(POVL)is a well described,but uncommon complication that may occur due to ischemia to the optic nerve,retina,or cerebral cortex.Closed-angle glaucoma and amaurosis have been reported as additional etiologies for vision loss following spinal surgery.Peripheral nerve injuries,such as those caused by prolonged traction to the brachial plexus,are more commonly encountered postoperative events.Myocutaneous complications including pressure ulcers and compartment syndrome may also occur after prone positioning,albeit rarely.Other uncommon positioning complications such as tongue swelling resulting in airway compromise,femoral artery ischemia,and avascular necrosis of the femoral head have also been reported.Many of these are well-understood and largely avoidable through thoughtful attention to detail.Other complications,such as POVL,remain incompletely understood and thus more difficult to predict or prevent.Here,the current literature on the complications of prone positioning for spine surgery is reviewed to increase awareness of the spectrum of potential complications and to inform spine surgeons of strategies to minimize the risk of prone patient morbidity.

Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review

Acute respiratory distress syndrome(ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first described 40 years ago and it proves to be in alignment with two major ARDS pathophysiological lung models; the "sponge lung"- and the "shape matching"-model. Current evidence strongly supports that prone positioning has beneficial effects on gas exchange, respiratory mechanics, lung protection and hemodynamics as it redistributes transpulmonary pressure, stress and strain throughout the lung and unloads the right ventricle. The factors that individually influence the time course of alveolar recruitment and the improvement in oxygenation during prone positioning have not been well characterized. Although patients' response to prone positioning is quite variable and hard to predict, large randomized trials and recent meta-analyses show that prone position in conjunction with a lung-protective strategy, when performed early and in sufficient duration, may improve survival in patients with ARDS. This pathophysiology-based review and recent clinical evidence strongly support the use of prone positioning in the early management of severe ARDS systematically and not as a rescue maneuver or a last-ditch effort.

Clinical evaluation of prone position ventilation in the treatment of acute respiratory distress syndrome induced by sepsis

BACKGROUND Acute respiratory distress syndrome(ARDS)is an acute,diffuse,inflammatory lung injury.Previous studies have shown prone position ventilation(PPV)to be associated with improvement in oxygenation.However,its role in patients with ARDS caused by sepsis remains unknown.AIM To analyze the clinical effects of PPV in patients with ARDS caused by sepsis.METHODS One hundred and two patients with ARDS were identified and divided into a control group(n=55)and a PPV treatment group(n=47).Outcomes included oxygenation index,lung compliance(Cst)and platform pressure(Pplat),which were compared between the two groups after ventilation.Other outcomes included heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),left ventricular ejection fraction(LVEF),the length of mechanical ventilation time and intensive care unit(ICU)stay,and levels of C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)after ventilation.Finally,mortality rate was also compared between the two groups.RESULTS On the first day after ventilation,the oxygenation index and Cst were higher and Pplat level was lower in the PPV group than in the conventional treatment group(P<0.05).There were no significant differences in oxygenation index,Cst,and Pplat levels between the two groups on the 2^(nd),4^(th),and 7^(th) day after ventilation(P>0.05).There were no significant differences in HR,MAP,CVP,LVEF,duration of mechanical ventilation and ICU stay,and the levels of CRP,PCT,and IL-6 between the two groups on the first day after ventilation(all P>0.05).The mortality rates on days 28 and 90 in the PPV and control groups were 12.77% and 29.09%,and 25.53% and 45.45%,respectively(P<0.05).CONCLUSION PPV may improve respiratory mechanics indices and may also have mortality benefit in patients with ARDS caused by sepsis.Finally,PPV was not shown to cause any adverse effects on hemodynamics and inflammation indices.

Sandwich Rolling over Method in Patients with Prone Position Ventilation

Background: Prone positioning is nowadays considered as one of the most effective strategies for patients with severe acute respiratory distress syndrome (ARDS). Prone position ventilation can lead to some severe complications. Effectively implement prone ventilation and reduce the incidence of complications become an important problem for clinical medical staff. Aims: To investigate whether the Sandwich rolling over method was convenient for clinical implementation and can reduce complications. Design: This is a single-center, retrospective, observational study. Results: The mean pronation cycles per patient were 6.11 ± 4.40. The mean time spent in prone position for each cycle was 10.05 ± 4.42 hours. Two patients developed a pressure sore and the positions were cheek, auricle and chest. The mean time it took from preparation to cover the patient with the quilt was 10.56 ± 4.35 minutes. Conclusions: This retrospective study has shown that under the close cooperation and supervision of the team, the implementation efficiency of prone position ventilation can be improved and the occurrence of complications can be reduced.

Short-term prone positioning for severe acute respiratory distress syndrome after cardiopulmonary bypass:A case report and literature review

BACKGROUND Aortic dissection is a complex and dangerous cardiovascular disease,with many complications in the perioperative period,including severe acute respiratory distress syndrome(ARDS),which affects prognosis and increases mortality.Despite the effect of prone positioning(PP)in improving oxygenation in patients with severe ARDS,reports about PP early after cardiac surgery are few and such an opt-ion may be an issue in cardiac surgery patients because of the recent sternotomy.CASE SUMMARY A 40-year-old male patient diagnosed with acute type A aortic dissection on October 22,2021 underwent ascending artery replacement plus total aortic arch replacement plus stent elephant trunk implantation under cardiopulmonary bypass.Unfortunately,he developed ARDS on postoperative day 1.Despite comprehensive treatment with aggressive pulmonary protective ventilation,fluid management with continuous renal replacement therapy,the condition continued to deteriorate and rapidly progressed to severe ARDS with a minimum oxygenation index of 51.We are ready to implement salvage therapy,including PP and extracorporeal membrane oxygenation(ECMO).Due to the large amount of pericardial mediastinal and thoracic drainage after thoracotomy,ECMO may result in massive postoperative bleeding.Prolonged prone ventilation is often inappropriate after thoracotomy.Therefore,we chose short-term PP for<6 h.Finally,the oxygenation index greatly improved and the diffuse exudation in both lungs of the patient was significantly reduced with short-term prone positioning.CONCLUSION Intermittent short-term PP can improve early postoperative severe ARDS after acute aortic dissection.

Prone Position: Does It Help with Acute Respiratory Distress Syndrome (ARDS) Requiring Extracorporeal Membrane Oxygenation (ECMO)?

Introduction: Lung protective ventilation therapy with low tidal volume-high PEEP is the standard treatment for the patients with acute respiratory distress syndrome (ARDS). Oscillators are occasionally used for salvage ventilation in cases where poor compliance restricts the use of traditional ventilation with ARDS. In addition to ventilator therapy, prone positioning has been used to improve oxygenation. We presented a challenging case of ARDS, which failed medical management extracorporeal membrane oxygenation (ECMO) support and oscillatory ventilation. Prone positioning was initiated which improved oxygenation, respiratory compliance and posterior atelectasis. Case presentation: A 41-year-old morbid obese female developed ARDS due to influenza pneumonia. The patient remained hypoxic despite optimum medical and ventilator management and required veno-venous extracorporeal membrane oxygenation (VV ECMO). CT scan of the chest showed ARDS with posterior consolidation. Despite ARDSnet ventilation support, antiviral therapy and ECMO support, there was no clinical improvement. High frequency oscillatory ventilation was initiated on ECMO day #13, which resulted in no respiratory improvement over the next 5 days. On ECMO day #18, the patient was placed on a Rotaprone? bed Therapy, utilizing a proning strategy of 16 hours a day. The clinical improvements observed were resolving of the consolidation on CXR, improvements in ventilatory parameters and decreased oxygen requirements. The patient was successfully weaned off ECMO on POD#25 (8 days post prone bed). Conclusions: Prone position improved oxygen saturation and pulmonary compliance in severe ARDS requiring ECMO and it might facilitate early weaning.

Comparison of Clinical Problems in Thoracoscopic Esophagectomy between Prone Position with Pneumothorax Procedure and Lateral Position

Study Objective: We compared the effects of intraoperative body position on blood gas and fluid balance in patients undergoing a thoracoscopic esophagectomy as well as during operation and postoperative laboratory data. Design: Prospective study. Setting: Operating room and intensive care unit. Patients: ASA physical status 1 and 2 patients (n = 26), scheduled for elective thoracoscopic esophagectomy and immediate reconstruction under general anesthesia with one-lung ventilation were enrolled. Interventions: Patients were assigned to either the lateral (n = 16) or prone (n = 10) position groups based on the planned intraoperative body position. A pneumothorax procedure was concomitantly performed only in the prone position group. Measurements: Fluid balance, PaO2/FIO2 ratio (P/F ratio), and maximum PaCO2 during the operation and postoperative laboratory data were analyzed. Main Results: There were no significant differences between the groups for amount of blood loss, blood transfusion, fluid infusion, or urine output. The P/F ratio during one-lung ventilation was significantly higher in the prone than the lateral position group (379 ± 122 vs. 297 ± 67 mmHg, p = 0.017), as was maximum intraoperative PaCO2 (72.2 ± 15.6 vs. 48.3 ± 6.3 mmHg, p Conclusions: A thoracoscopic esophagectomy in the prone position performed concomitantly with a CO2 pneumothorax procedure resulted in a significantly better P/F ratio during one-lung ventilation as compared to the lateral position, indicating that the prone position is more advantageous for oxygenation.

Cardiopulmonary Resuscitation in the Prone Position

Cardiac arrest in unusual positions represents an additional challenge for anesthesiologists. This paper reports a successful cardiopulmonary resuscitation during neurosurgical procedure in which high-quality chest compressions was performed in the prone position. The aim of this report is disclose the knowledge of resuscitation maneuvers in a position other than supine. A 77-year-old female patient presented for excision of parietal-occipital meningioma in the prone position with the head fixed on a Mayfield head-holder. During the surgical procedure the sagittal sinus was disrupted. The patient presented an abrupt hemorrhagic shock leading to a cardiac arrest by hypovolemia despite vigorous volume replacement. Cardiac massage was promptly initiated in the prone position. After two minutes, there was a return of spontaneous circulation. The patient was discharged without sequelae. We concluded that high-quality chest compressions in the prone position were able to generate sufficient cardiac output.

Umbilical Catheter Complications in Newborns during Prone Position: A Pilot Study

Introduction: It is not known whether prone position of newborns with umbilical catheters increases the complication risk. Purpose: Analysing complications of umbilical catheters in newborns during prone positioning and analysing if local complications as a wet or red rim increase severe complications. Subjects: Newborns (

Comparison of the dose to lung volume between supine and prone position during treatment planning

Objective The aim of the study was to compare the dose to lung volume in the supine and prone posi- tion while designing CyberKnife treatment plans to treat metastatic tumors in the spinous processes of the thoracic vertebrae, and offer a reference for reducing damage to normal tissues. Methods Nine cases of metastatic tumors in the spinous processes of the thoracic vertebrae were selected, and then we designed treatment plans based on the supine and prone positions and compared the results. Results In contrast with the treatment plan based on the prone position, the one for the supine position required 14862-36337 MU more; the lung D5% was 5.20-7.90 Gy higher; and the lung D20% was 2.61-5.73 Gy higher. The difference of dose to spine volume between the two plans was -2.21-2.67 Gy; to the skin volume was -3.93-7.85 Gy; and to the esophagus was 0.28-6.39 Gy. Conclusion The treatment plan based on the prone position of patients can better protect lung tissues than the one based on the supine position, and can also improve the avaUabilitv of beams.

Prone position combined with high-flow nasal oxygen could benefit spontaneously breathing, severe COVID-19 patients:A case report

BACKGROUND Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.CASE SUMMARY In this case report,we describe a case of the successful combination of the prone position(PP)and high-flow nasal oxygen(HFNO)therapy in a spontaneously breathing,severe COVID-19 patient who presented with fever,fatigue and hypoxemia and was diagnosed by positive throat swab COVID-19 RNA testing.The therapy significantly improved the patient's clinical symptoms,oxygenation status,and radiological characteristics of lung injury during hospitalization,and the patient showed good tolerance and avoided intubation.Additionally,we did not find that medical staff wearing optimal airborne personal protective equipment(PPE)were infected by the new coronavirus in our institution.CONCLUSION We conclude that the combination of PP and HFNO could benefit spontaneously breathing,severe COVID-19 patients.The therapy does not increase risk of healthcare workers wearing optimal airborne PPE to become infected with virus particles.

The efficacy and safety of one-stage endoscopy combined with intrarenal surgery(mini-nephrostomy tract)in the prone split-leg position for complex renal calculi

Background:The goal of this study was to determine the safety and efficacy of endoscopic combined intrarenal surgery(ECIRS)performed in the prone split-leg position for the treatment of complex renal stones.Materials and methods:A mature ECIRS protocol was designed.Retrospective analysis was conducted of medical records between January 2020 and December 2021 of patients with complex renal stones at one center who underwent ECIRS by 2 skilled surgeons using retrograde flexible ureteroscopy and mini-percutaneous nephrolithotomy in the prone split-leg position.Results:A total of 44 patients were included in this study.Mean stone size was 26.1±12.7 mm,and the number of calyces involved was 4.36±2.09.Mean operative time was 71.1±21.8 minutes.Postoperative decline in hemoglobin was 15.8±9.8 g/L.Seventy-five percent of patients achieved stone-free status.The mean number of residual stones was 2.8±2.3,and the mean residual stone size was 10.30±4.76 mm.Six patients(13.6%)developed postoperative complications,including 4 with fever during the first 2 days postoperatively and 2 patients with transient postoperative pain.No patients developed severe complications.Conclusions:Endoscopic combined intrarenal surgery in the prone split-leg position can be performed safely by experienced surgeons using retrograde flexible ureteroscopy in conjunction with mini-percutaneous nephrolithotomy as a successful technique for the treatment of complex renal stones.

不同重力喂养高度及卧位在预防早产儿胃食管反流中的效果分析

目的探讨不同重力喂养高度及卧位预防早产儿胃食管反流的效果。方法选取中国医科大学附属盛京医院新生儿科2022年6—12月出生的早产儿138例为研究对象,按照随机数字表法分为对照组、观察1组、观察2组,每组46例。对照组采用常规仰卧位重力喂养;观察1组采取右侧卧位,确认无残留奶量后,抬高针筒至距离早产儿嘴唇上方20 cm处;观察2组采取俯卧位,其他步骤同观察1组。比较3组呕吐、溢奶、呼吸暂停、血氧饱和度下降、胃残留、减量喂养次数、停喂次数、体质量增长、排便次数、排便量、胎便排尽用时、潴留量及喂养2周后食管24 h反流监测等指标。结果3组早产儿人均喂养次数均为112次;观察1组和观察2组呕吐、溢奶、呼吸暂停、血氧浓度下降等发生率均低于对照组,差异有统计学意义(P<0.05);观察1组和观察2组胃残留比率低于对照组,体质量增长大于对照组,差异均有统计学意义(P<0.05);观察1组和观察2组减量喂养次数、停喂次数均少于对照组,差异有统计学意义(P<0.05);观察1组和观察2组排便次数、排便量均大于对照组,胎便排尽用时、潴留量均小于对照组,差异有统计学意义(P<0.05);观察1组和观察2组食管pH<4次数、反流超过5 min次数、最长单次反流持续时间及反流指数均小于对照组,差异有统计学意义(P<0.05)。结论重力喂养高度及体位改变可降低呕吐、溢奶、呼吸暂停和血氧浓度下降等发生率,预防胃食管反流,有利于早产儿生长发育。

俯卧位通气相关面部压力性损伤危险因素分析及最佳建模方法选择

背景面部压力性损伤是俯卧位通气患者常见并发症,创面局部暴露可增加全身感染风险,影响俯卧位通气治疗效果,甚至造成局部组织永久性功能损害。探讨其危险因素并构建预测模型对于预防俯卧位通气相关面部压力性损伤具有重要临床意义。目的探讨俯卧位通气相关面部压力性损伤的危险因素及其最佳建模方法。方法选择2020年6月—2023年3月入住新疆医科大学第一附属医院重症医学科的159例接受俯卧位通气的患者为研究对象,根据是否发生面部压力性损伤分为压力性损伤组(n=22)和非压力性损伤组(n=137),收集患者的一般信息、疾病诊断、治疗措施、实验室检查。分别使用逐步Logistic回归模型、全变量Logistic回归模型及Lasso-Logistic回归模型筛选面部压力性损伤危险因素并建立预测模型,应用受试者工作特征曲线下面积(AUC)评价模型区分度;应用赤池信息准则(AIC)、贝叶斯信息准则(BIC)及校准曲线评价模型校准度;应用决策曲线评价模型临床应用价值。通过比较三种Logistic回归模型预测效能和临床应用差异选择最佳建模方法。结果逐步Logistic回归模型结果显示,面部压力性损伤的影响因素为年龄(OR=39.041)、糖尿病(OR=7.256)和单次俯卧位通气时间(OR=6.705);全变量Logistic回归模型结果显示,面部压力性损伤的影响因素为年龄(OR=26.882)、糖尿病(OR=1.770)、ICU住院时间(OR=2.610)和单次俯卧位通气时间(OR=5.340);Lasso-Logistic回归结果显示,面部压力性损伤的影响因素为年龄(OR=38.256)、糖尿病(OR=1.094)、单次俯卧位通气时间(OR=5.738)和Richmond躁动镇静评分(OR=1.179)。Lasso-Logistic回归模型预测俯卧位通气相关面部压力性损伤的AUC、灵敏度和特异度分别为0.855、0.959和0.750,优于逐步和全变量Logistic回归模型;AIC和BIC分别为44.634和55.745,低于逐步和全变量Logistic回归模型;校准曲线显示Lasso-Logistic回归模型预测概率与实际概率拟合效果最佳。决策曲线显示Lasso-Logistic回归模型获得临床收益对应风险阈值为0.01~0.98,优于逐步和全变量Logistic回归模型。结论年龄、糖尿病、单次俯卧位通气时长和Richmond躁动镇静评分是俯卧位通气相关面部压力性损伤的危险因素,Lasso-Logistic回归模型预测效能和临床应用价值优于逐步Logistic回归模型和全变量Logistic回归模型,是最佳建模方法。