title: Can the tomographic aspect characteristics of patients presenting with acute respiratory distress syndrome predict improvement in oxygenation-related response to the prone position?
abstract: BACKGROUND
  In some patients with acute respiratory distress syndrome, the prone position is able to improve oxygenation, whereas in others it is not. It could be hypothesized that the more opacities that are present in dependent regions of the lung when the patient is in the supine position, the better the improvement in oxygenation is observed when the patients are turned prone. Therefore, we conducted a prospective study to identify computed tomographic scan aspects that could accurately predict who will respond to the prone position.
  
  
  METHODS
  We included 46 patients with acute respiratory distress syndrome (31 responders and 15 nonresponders). Computed tomographic scan was performed in the 6-h period preceding prone position. Blood gas analyses were performed before and at the end of the first 6-h period of prone position.
  
  
  RESULTS
  Arterial oxygen partial pressure/fraction of inspired oxygen increased from 117 +/- 42 (mean +/- SD) in the supine position to 200 +/- 76 mmHg in the prone position (P < 0.001). There were 31 responders and 15 nonresponders. There was a vertebral predominance of the opacities (P < 0.0001). However, there was no difference between responders and nonresponders. When only the amount of consolidated lung located under the heart was evaluated, there was more consolidated tissue under the heart relative to total lung area in nonresponders than in responders (P = 0.01).
  
  
  CONCLUSIONS
  There are no distinctive morphologic features in the pattern of lung disease measured by computed tomographic scanning performed with the patient in the supine position that can predict response to the prone position.
authors.affiliation: Polyvalent Intenstive Care Unit, Hôpital Sainte-Marguerite, Marseille, France. lpapazian@mail.ap-hm.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
authors.forename: Marie-Héléne
authors.initials: MH
authors.lastname: Paladini
authors.forename: Fabienne
authors.initials: F
authors.lastname: Bregeon
authors.forename: Xavier
authors.initials: X
authors.lastname: Thirion
authors.forename: Olivier
authors.initials: O
authors.lastname: Durieux
authors.forename: Marc
authors.initials: M
authors.lastname: Gainnier
authors.forename: Laetitia
authors.initials: L
authors.lastname: Huiart
authors.forename: Serge
authors.initials: S
authors.lastname: Agostini
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Auffray
mesh_terms: D000368:Aged; D001784:Blood Gas Analysis; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy; D011237:Predictive Value of Tests; D016684:Prone Position / Q000502:physiology*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging* / Q000628:therapy*; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D010100:Oxygen