Prone position as prevention of lung injury in comatose patients: a prospective, randomized, controlled study.
OBJECTIVE
Comatose patients frequently exhibit pulmonary function worsening, especially in cases of pulmonary infection. It appears to have a deleterious effect on neurologic outcome. We therefore conducted a randomized trial to determine whether daily prone positioning would prevent lung worsening in these patients.


METHODS
Prospective, randomized, controlled study.


METHODS
Sixteen-bed intensive care unit.


METHODS
Fifty-one patients who required invasive mechanical ventilation because of coma with Glascow coma scores of 9 or less.


METHODS
In the prone position (PP) group: prone positioning for 4 h once daily until the patients could get up to sit in an armchair; in the supine position (SP) group: supine positioning.


RESULTS
The primary end point was the incidence of lung worsening defined by an increase in the Lung Injury Score of at least 1 point since the time of randomization. The secondary end point was the incidence of ventilator-associated pneumonia (VAP). A total of 25 patients were randomly assigned to the PP group and 26 patients to the SP group. The characteristics of the patients from the two groups were similar at randomization. The incidence of lung worsening was lower in the PP group (12%) than in the SP group (50%) ( p=0.003). The incidence of VAP was 20% in the PP group and 38.4% in the SP group ( p=0.14). There was no serious complication attributable to prone positioning, however, there was a significant increase of intracranial pressure in the PP.


CONCLUSIONS
In a selected population of comatose ventilated patients, daily prone positioning reduced the incidence of lung worsening.
Beuret
Pascal
P
Intensive Care Unit, Centre Hospitalier Roanne, 28 rue de Charlieu, 42328 Roanne, France. pascal.beuret@ch-roanne.fr
Carton
Marie-Jose
MJ
Nourdine
Karim
K
Kaaki
Mahmoud
M
Tramoni
Gerard
G
Ducreux
Jean-Claude
JC
D016009:Chi-Square Distribution; D003128:Coma / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D007427:Intracranial Pressure; D008297:Male; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D016684:Prone Position; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000009:adverse effects*