Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial.
OBJECTIVE
We examined the effect on survival of prone positioning as an early and continuous treatment in ARDS patients already treated with protective ventilation.


METHODS
Open randomized controlled trial in 17 medical-surgical ICUs.


METHODS
Forty mechanically ventilated patients with early and refractory ARDS despite protective ventilation in the supine position.


METHODS
Patients were randomized to remain supine or be moved to early (within 48[Symbol: see text]h) and continuous (> or = 20 h/day) prone position until recovery or death. The trial was prematurely stopped due to a low patient recruitment rate.


RESULTS
Clinical characteristics, oxygenation, lung pressures, and hemodynamics were monitored. Need for sedation, complications, length of MV, ICU, and hospital stays, and outcome were recorded. PaO(2)/FIO(2) tended to be higher in prone than in supine patients after 6[Symbol: see text]h (202 +/-78 vs. 165+/-70 mmHg); this difference reached statistical significance on day 3 (234+/-85 vs. 159+/-78). Prone-related side effects were minimal and reversible. Sixty-day survival reached the targeted 15% absolute increase in prone patients (62% vs. 47%) but failed to reach significance due to the small sample.


CONCLUSIONS
Our study adds data that reinforce the suggestion of a beneficial effect of early continuous prone positioning on survival in ARDS patients.
Fernandez
Rafael
R
CIBER Enfermedades Respiratorias, Hospital de Sabadell, Parc Taulis/n, 08208, Sabadell, Spain. rfernandez@tauli.cat
Trenchs
Xavier
X
Klamburg
Jordi
J
Castedo
Jon
J
Serrano
Jose Manuel
JM
Besso
Guillermo
G
Tirapu
Juan Pedro
JP
Santos
Antonio
A
Mas
Arantxa
A
Parraga
Manuel
M
Jubert
Paola
P
Frutos
Fernando
F
Añon
Jose Manuel
JM
Garcia
Manuela
M
Rodriguez
Fernando
F
Yebenes
Joan Carles
JC
Lopez
Maria Jesus
MJ
D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000145:classification / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index