title: Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial.
abstract: 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.
authors.affiliation: CIBER Enfermedades Respiratorias, Hospital de Sabadell, Parc Taulis/n, 08208, Sabadell, Spain. rfernandez@tauli.cat
authors.forename: Rafael
authors.initials: R
authors.lastname: Fernandez
authors.forename: Xavier
authors.initials: X
authors.lastname: Trenchs
authors.forename: Jordi
authors.initials: J
authors.lastname: Klamburg
authors.forename: Jon
authors.initials: J
authors.lastname: Castedo
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Serrano
authors.forename: Guillermo
authors.initials: G
authors.lastname: Besso
authors.forename: Juan Pedro
authors.initials: JP
authors.lastname: Tirapu
authors.forename: Antonio
authors.initials: A
authors.lastname: Santos
authors.forename: Arantxa
authors.initials: A
authors.lastname: Mas
authors.forename: Manuel
authors.initials: M
authors.lastname: Parraga
authors.forename: Paola
authors.initials: P
authors.lastname: Jubert
authors.forename: Fernando
authors.initials: F
authors.lastname: Frutos
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Añon
authors.forename: Manuela
authors.initials: M
authors.lastname: Garcia
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodriguez
authors.forename: Joan Carles
authors.initials: JC
authors.lastname: Yebenes
authors.forename: Maria Jesus
authors.initials: MJ
authors.lastname: Lopez
mesh_terms: 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