title: Study of prone positioning to reduce ventilator-associated pneumonia in hypoxaemic patients.
abstract: The aim of the present study was to examine whether prone positioning (PP) affects ventilator associated-pneumonia (VAP) and mortality in patients with acute lung injury/adult respiratory distress syndrome. 2,409 prospectively included patients were admitted over 9 yrs (2000-2008) to 12 French intensive care units (ICUs) (OUTCOMEREA). The patients required invasive mechanical ventilation (MV) and had arterial oxygen tension/inspiratory oxygen fraction ratios <300 during the first 48 h. Controls were matched to PP patients on the PP propensity score (+/-10%), MV duration longer than that in PP patients before the first turn prone, and centre. VAP incidence was similar in the PP and control groups (24 versus 13 episodes.1,000 patient-days MV(-1) respectively, p = 0.14). After adjustment, PP did not decrease VAP occurrence (HR 1.64 (95% CI 0.70-3.84); p = 0.25) but significantly delayed hospital mortality (HR 0.56 (95% CI 0.39-0.79); p = 0.001), without decreasing 28-day mortality (37% in both groups). Post hoc analyses indicated that PP did not protect against VAP but, when used for >1 day, might decrease mortality and benefit the sickest patients (Simplified Acute Physiology Score >50). In ICU patients with hypoxaemic acute respiratory failure, PP had no effect on the risk of VAP. PP delayed mortality without decreasing 28-day mortality. PP >1 day might decrease mortality, particularly in the sickest patients.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Medical ICU, Colombes, France.
authors.forename: R
authors.initials: R
authors.lastname: Mounier
authors.forename: C
authors.initials: C
authors.lastname: Adrie
authors.forename: A
authors.initials: A
authors.lastname: Français
authors.forename: M
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: C
authors.initials: C
authors.lastname: Cheval
authors.forename: B
authors.initials: B
authors.lastname: Allaouchiche
authors.forename: S
authors.initials: S
authors.lastname: Jamali
authors.forename: A T
authors.initials: AT
authors.lastname: Dinh-Xuan
authors.forename: D
authors.initials: D
authors.lastname: Goldgran-Toledano
authors.forename: Y
authors.initials: Y
authors.lastname: Cohen
authors.forename: E
authors.initials: E
authors.lastname: Azoulay
authors.forename: J-F
authors.initials: JF
authors.lastname: Timsit
authors.forename: J-D
authors.initials: JD
authors.lastname: Ricard
mesh_terms: D000208:Acute Disease; D000368:Aged; D016022:Case-Control Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000401:mortality* / Q000628:therapy*; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D011237:Predictive Value of Tests; D016684:Prone Position; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000401:mortality*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy; D012307:Risk Factors