PRoAcT–COVID will provide a detailed description of various important aspects of care in criticically ill COVID–19 patients in a large set of hospitals in the Netherlands.

The database of PRoAcT–COVID contains granular data on types of oxygen support and awake prone positioning; ventilatory support; rescue therapies for hypoxemia; thromboprophylaxis and anticoagulation; antiviral and immunomodulating therapies; and experimental supportive treatments in the ICU up till day 28. Follow–up regarding outcomes will be till day 90.

PRoAcT–COVID includes consecutive patients in the first 3 month of the second outbreak in the Netherlands, from September 2020, to December 2020.

PRoAcT–COVID is registered at clinicaltrials.gov, NCT04719182.

The study protocol of PRoAcT–COVID will be published soon.

Prone positioning improves survival and shorten duration of ventilation in invasively ventilated patients with severe ARDS. Awake proning may result in lower intubation and mortality rates in COVID-19 patients with hypoxemia refractory to simple oxygen therapy. Evidence for benefit, though, remains scarce and there is no consensus on how (long) and when to apply awake proning.

In this project we will study the incidence of awake proning, duration of proning, and associations with outcomes, including intubation rate, duration of ventilatory support and stay in ICU, and mortality.

The incidence of thrombosis in patients with COVID–19 is high, despite use of pharmaco-thromboprophylaxis. The Dutch guideline for thromboprophylaxis in COVID–19 patients suggested doubling the pharmaco-thromboprophylaxis dose.

How effective is, and what are the adverse effects of a higher dose of pharmaco-thromboprophylaxis?

Since the start of this pandemic the association between coagulopathy and COVID–19 has been thoroughly described but there is few data reported on the association of the use of thromboprophylaxis and mortality in ICU patients with COVID–19.

In this project we will study practice of pharmaco-thromboprophylaxis, and associations with outcomes, including deep venous thormbosis and pulmonary embolism, duration of ventilatory support and stay in ICU, and mortality.

In addition to antiviral medication and immune therapies for the treatment of COVID-19, experimental adjuvant therapies, like Vitamin C, D and zinc, are used.

In Dutch hospitals experimental treatments for COVID-19 are inconsistently used. However, actual practice is uncertain, and the on outcome are uncertain.

In this project we will study practice of various experimental adjuvant therapies, side-effects and associations with outcomes, including duration of ventilatory support and stay in ICU, and mortality.

Since the start of the pandemic, many treatments have been tested, all of which having the potential to improve outcome of COVID–19 patients. Especially within the field of immunomodulating strategies, the number of agents is rapidly increasing.

By now, dexamethasone is standard care for all hospitalized COVID–19 patients, and tocilizumab is suggested for critically ill patients with evidence of a hyperinflammatory response.

It remains uncertain whether immunomodulating strategies like chloroquine and convalescent plasma also have the potential to improve outcomes. It is unclear how all these strategies were used during the second wave of the COVID–19 pandemic in the Netherlands, and if these treatments had an association with outcome.