A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome.
BACKGROUND
Ventilation in the prone position for about 7 h/d in patients with acute respiratory distress syndrome (ARDS), acute lung injury, or acute respiratory failure does not decrease mortality. Whether it is beneficial to administer prone ventilation early, and for longer periods of time, is unknown.


METHODS
We enrolled 136 patients within 48 h of tracheal intubation for severe ARDS, 60 randomized to supine and 76 to prone ventilation. Guidelines were established for ventilator settings and weaning. The prone group was targeted to receive continuous prone ventilation treatment for 20 h/d.


RESULTS
The intensive care unit mortality was 58% (35/60) in the patients ventilated supine and 43% (33/76) in the patients ventilated prone (p = 0.12). The latter had a higher simplified acute physiology score II at inclusion. Multivariate analysis showed that simplified acute physiology score II at inclusion (odds ratio [OR], 1.07; p < 0.001), number of days elapsed between ARDS diagnosis and inclusion (OR, 2.83; p < 0.001), and randomization to supine position (OR, 2.53; p = 0.03) were independent risk factors for mortality. A total of 718 turning procedures were done, and prone position was applied for a mean of 17 h/d for a mean of 10 d. A total of 28 complications were reported, and most were rapidly reversible.


CONCLUSIONS
Prone ventilation is feasible and safe, and may reduce mortality in patients with severe ARDS when it is initiated early and applied for most of the day.
Mancebo
Jordi
J
Department of Intensive Care Medicine and Epidemiology, Hospital de Sant Pau, Barcelona, Spain. jmancebo@santpau.es
Fernández
Rafael
R
Blanch
Lluis
L
Rialp
Gemma
G
Gordo
Federico
F
Ferrer
Miquel
M
Rodríguez
Fernando
F
Garro
Pau
P
Ricart
Pilar
P
Vallverdú
Immaculada
I
Gich
Ignasi
I
Castaño
José
J
Saura
Pilar
P
Domínguez
Guillermo
G
Bonet
Alfons
A
Albert
Richard K
RK
D018806:APACHE; D018592:Cross-Over Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D016684:Prone Position; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D016683:Supine Position