20 Dec 08

Prone positioning in acute respiratory distress syndrome

Posted in ALI/ARDS, Mechanical ventilation at 0:21 by Laci

By R Fernandez, X Trenchs, J Klamburg, J Castedo, J M Serrano et al

Intensive Care Med 2008:34;1487-1491

We examined the effect on survival of prone positioning as an early and continuous treatment in ARDS patients already treated with protective ventilation.

Design and setting
Open randomized controlled trial in 17 medical-surgical ICUs.

Patients
Forty mechanically ventilated patients with early and refractory ARDS despite protective ventilation in the supine position.
Interventions  Patients were randomized to remain supine or be moved to early (within 48h) and continuous (=20h/day) prone position until recovery or death. The trial was prematurely stopped due to a low patient recruitment rate.

Measurements and results
Clinical characteristics, oxygenation, lung pressures, and hemodynamics were monitored. Need for sedation, complications, length of MV, ICU, and hospital stays, and outcome were recorded. PaO₂/FIO₂ tended to be higher in prone than in supine patients after 6h (202±78 vs. 165±70mmHg); this difference reached statistical significance on day 3 (234±85 vs. 159±78). Prone-related side effects were minimal and reversible. Sixty-day survival reached the targeted 15% absolute increase in prone patients (62% vs. 47%) but failed to reach significance due to the small sample.

Conclusions
Our study adds data that reinforce the suggestion of a beneficial effect of early continuous prone positioning on survival in ARDS patients.

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