[Comparison of incomplete (135 degrees ) and complete prone position (180 degrees ) in patients with acute respiratory distress syndrome. Results of a prospective, randomised trial].
BACKGROUND
Ventilation in the prone position is carried out for improvement of pulmonary gas exchange in patients with acute respiratory distress syndrome (ARDS). We compared the effects of an incomplete prone position (IPP, 135( degrees )) with a complete prone position (CPP, 180( degrees )) in patients with ARDS.


METHODS
For this trial 59 patients with ARDS were randomly assigned and were positioned in a "cross-over" design: patients of group A were placed in IPP for 6 h and then immediately positioned in CPP for another 6 h. Patients in group B were positioned in reverse order. Blood gases, hemodynamic measurements, quasistatic respiratory compliance and assessments of side effects were performed before begin, 30 min and 6 h after first positioning, then 30 min and 6 h after second positioning and 2 after repositioning.


RESULTS
Turning patients in IPP and CPP resulted in a significant increase in the arterial oxygenation index (p(a)O(2)/F(I)O(2)), but this effect was more pronounced in the CPP (before: 142+/-46 mm Hg, 6 h: 253+/-107 mm Hg) than in the IPP (before: 139+/-54 mm Hg, 6 h: 206+/-75 mm Hg), and compliance was improved only in CPP. The improvement in arterial oxygenation persisted 2 h after repositioning in the supine position in both groups. The oxygenation responder rate was lower during the IPP (70.3%) in comparison with the CPP (84.0%, p<0.05). The incidence of side effects tended to be increased during the CPP.


CONCLUSIONS
Incomplete prone position improves oxygenation in ARDS patients, but less effectively than a "classic" CPP. In these patients the use of a CPP should be preferred.
Bein
T
T
Kliniken für Anästhesiologie, Universitätsklinikum Regensburg. thomas.bein@klinik.uni-regensburg.de
Sabel
K
K
Scherer
A
A
Papp-Jambor
C
C
Hekler
M
M
Dubb
R
R
Schlitt
H J
HJ
Taeger
K
K
D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D018592:Cross-Over Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008170:Lung Compliance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D016684:Prone Position / Q000502:physiology*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012129:Respiratory Function Tests
D002245:Carbon Dioxide; D010100:Oxygen
Vergleich von inkompletter (135 degrees) und kompletter Bauchlage (180 degrees) beim schweren akuten Lungenversagen. Ergebnisse einer prospektiven, randomisierten Untersuchung.