A prospective survey of early 12-h prone positioning effects in patients with the acute respiratory distress syndrome.
OBJECTIVE
To evaluate of the oxygenation effects of 12-h prone positioning (PP) in ARDS patients and to assess the safety of such a procedure.


METHODS
Prospective observational study in a medical intensive care unit (12 beds) of a university hospital.


METHODS
51 consecutive ARDS patients.


METHODS
PP for at least 12 h daily until recovery or death.


RESULTS
Arterial blood gases were collected before and during PP and 1 h after return to supine. Turning adverse events, cutaneous bedsores, and enteral nutrition intolerance were specifically monitored and collected daily by a referring physician. In total 224 PP sessions were performed. Oxygenation improved 1 h after the turn and continued improving over the 12-h period (4). The beneficial effect persisted 1 h after return to supine (01). We considered 96% patients responders: 45% as early responders and 53% persistent responders (persistent benefit after return to supine). Four significant adverse events occurred during the 448 turning maneuvers (0.9%). Stage III ulceration and stage IV necrosis cutaneous bedsores occurred in ten patients (20%). Enteral nutrition intolerance was reported in 25% but without inability to meet patient's caloric requirement.


CONCLUSIONS
Twelve-hour PP is a safe procedure and allows a continuous oxygenation improvement throughout the entire session.
L'Her
Erwan
E
Réanimation et Urgences Médicales, CHU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. elher@univ-brest.fr
Renault
Anne
A
Oger
Emmanuel
E
Robaux
Marie-Aline
MA
Boles
Jean-Michel
JM
D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D008297:Male; D016684:Prone Position; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000628:therapy*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000009:adverse effects