Improved oxygenation utilizing a prone positioner in patients with acute respiratory distress syndrome.
OBJECTIVE
(a) To determine whether placing patients with acute respiratory distress syndrome in the prone position by a light-weight portable support frame improves oxygenation, (b) whether one can determine which patients benefit from prone positioning, and (c) to determine an effective technique for prone positioning of patients.


METHODS
Prospective, controlled trial without blinding.


METHODS
Medical intensive care units in two urban university-affiliated hospitals.


METHODS
Fifteen patients meeting a standard definition for acute respiratory distress syndrome were studied prospectively. Each patient acted as his own control for purposes of comparison.


METHODS
Patients were assigned randomly to begin in either supine or prone positions. The positioning frame was used to turn patients from one position to the other, and oxygenation, ventilation, respiratory mechanics, and hemodynamics were measured.


RESULTS
Significantly better oxygenation was seen in the prone positions than in the supine (P < 0.05). In the overall population there was a decrease in AaDO2 of 21 mmHg when the patients were placed prone. The groups were then divided into responders (n = 9) and nonresponders (n = 6). There were significant differences between the groups (but not between positions) regarding PaO2, baseline, PaCO2, pulmonary artery pressures, and peak inspiratory pressures on the ventilator and in ICU length of stay and time on mechanical ventilatory support.


CONCLUSIONS
Prone positioning improves oxygenation in the majority of patients studied and can be achieved relatively easily.
Vollman
K M
KM
Medical Critical Care, Henry Ford Hospital, Detroit, MI, USA.
Bander
J J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay; D017770:Lifting; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D016684:Prone Position; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016683:Supine Position
D010100:Oxygen