Prone positioning for acute respiratory distress syndrome in the surgical intensive care unit: who, when, and how long?
BACKGROUND
We evaluated the effects of prone positioning (PP) on surgery and trauma patients with acute respiratory distress syndrome (ARDS).


METHODS
Patients with ARDS were studied. Exclusion criteria were contraindications to PP. Patients were evaluated in the supine position and after being turned to the PP. After 6 hours, patients were returned to the supine position for 3 hours. One hour after each position change, arterial and mixed venous blood was drawn and analyzed for blood gases and pH, and hemodynamics were measured.


RESULTS
Over 20 months, 27 patients met the criteria, and 20 of the patients were entered into the study. On day 1, 18 of 20 patients (90%) responded with an increase in PaO(2) during PP. On day 2, 16 of 17 patients (94%) responded; on day 3, 15 of 16 patients responded (94%); on day 4, 11 of 13 patients responded (85%); on day 5, 8 of 8 patients responded (100%); and on day 6, 4 of 5 patients responded (80%). Pao(2)/Fio(2) and Qs/Qt were significantly improved (P<.05) during PP. There were 91 periods of PP, lasting 10.3+/-1.2 hours. Of 91 changes to PP, 78 changes (86%) resulted in an improvement in Pao(2)/Fio(2) of more than 20%.


CONCLUSIONS
PP improves oxygenation in ARDS for 6 days with few complications.
Johannigman
J A
JA
Department of Surgery, University of Cincinnati, Cincinnati, Ohio 45267-0558, USA.
Davis
K
K
Miller
S L
SL
Campbell
R S
RS
Luchette
F A
FA
Frame
S B
SB
Branson
R D
RD
D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D003422:Critical Care / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008170:Lung Compliance; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration; D011182:Postoperative Care / Q000379:methods*; D016684:Prone Position / Q000502:physiology; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D016896:Treatment Outcome
D010100:Oxygen