title: Effect of prone positioning on the survival of patients with acute respiratory failure.
abstract: BACKGROUND
  Although placing patients with acute respiratory failure in a prone (face down) position improves their oxygenation 60 to 70 percent of the time, the effect on survival is not known.
  
  
  METHODS
  In a multicenter, randomized trial, we compared conventional treatment (in the supine position) of patients with acute lung injury or the acute respiratory distress syndrome with a predefined strategy of placing patients in a prone position for six or more hours daily for 10 days. We enrolled 304 patients, 152 in each group.
  
  
  RESULTS
  The mortality rate was 23.0 percent during the 10-day study period, 49.3 percent at the time of discharge from the intensive care unit, and 60.5 percent at 6 months. The relative risk of death in the prone group as compared with the supine group was 0.84 at the end of the study period (95 percent confidence interval, 0.56 to 1.27), 1.05 at the time of discharge from the intensive care unit (95 percent confidence interval, 0.84 to 1.32), and 1.06 at six months (95 percent confidence interval, 0.88 to 1.28). During the study period the mean (+/-SD) increase in the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen, measured each morning while patients were supine, was greater in the prone than the supine group (63.0+/-66.8 vs. 44.6+/-68.2, P=0.02). The incidence of complications related to positioning (such as pressure sores and accidental extubation) was similar in the two groups.
  
  
  CONCLUSIONS
  Although placing patients with acute respiratory failure in a prone position improves their oxygenation, it does not improve survival.
authors.affiliation: Istituto di Anestesia e Rianimazione,  Università di Milano, Ospedale Maggiore di Milano, Milan, Italy. gattinon@polic.cilea.it
authors.forename: L
authors.initials: L
authors.lastname: Gattinoni
authors.forename: G
authors.initials: G
authors.lastname: Tognoni
authors.forename: A
authors.initials: A
authors.lastname: Pesenti
authors.forename: P
authors.initials: P
authors.lastname: Taccone
authors.forename: D
authors.initials: D
authors.lastname: Mascheroni
authors.forename: V
authors.initials: V
authors.lastname: Labarta
authors.forename: R
authors.initials: R
authors.lastname: Malacrida
authors.forename: P
authors.initials: P
authors.lastname: Di Giulio
authors.forename: R
authors.initials: R
authors.lastname: Fumagalli
authors.forename: P
authors.initials: P
authors.lastname: Pelosi
authors.forename: L
authors.initials: L
authors.lastname: Brazzi
authors.forename: R
authors.initials: R
authors.lastname: Latini
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration; D003668:Pressure Ulcer / Q000209:etiology; D016684:Prone Position; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012306:Risk; D012720:Severity of Illness Index; D016683:Supine Position
chemical_list: D010100:Oxygen