title: Feasibility and effectiveness of prone position in morbidly obese patients with ARDS: a case-control clinical study.
abstract: BACKGROUND
  Obese patients are at risk for developing atelectasis and ARDS. Prone position (PP) may reduce atelectasis, and it improves oxygenation and outcome in severe hypoxemic patients with ARDS, but little is known about its effect in obese patients with ARDS.
  
  
  METHODS
  Morbidly obese patients (BMI ≥ 35 kg/m²) with ARDS (Pao₂/FIo₂ ratio ≤ 200 mm Hg) were matched to nonobese (BMI < 30 kg/m²) patients with ARDS in a case-control clinical study. The primary end points were safety and complications of PP; the secondary end points were the effect on oxygenation (Pao₂/FIo₂ ratio at the end of PP), length of mechanical ventilation and ICU stay, nosocomial infections, and mortality.
  
  
  RESULTS
  Between January 2005 and December 2009, 149 patients were admitted for ARDS. Thirty-three obese patients were matched with 33 nonobese patients. Median (25th-75th percentile) PP duration was 9 h (6-11 h) in obese patients and 8 h (7-12 h) in nonobese patients (P = .28). We collected 51 complications: 25 in obese and 26 in nonobese patients. The number of patients with at least one complication was similar across groups (n = 10, 30%). Pao₂/FIo₂ ratio increased significantly more in obese patients (from 118 ± 43 mm Hg to 222 ± 84 mm Hg) than in nonobese patients (from 113 ± 43 mm Hg to 174 ± 80 mm Hg; P = .03). Length of mechanical ventilation, ICU stay, and nosocomial infections did not differ significantly, but mortality at 90 days was significantly lower in obese patients (27% vs 48%, P < .05).
  
  
  CONCLUSIONS
  PP seems safe in obese patients and may improve oxygenation more than in nonobese patients. Obese patients could be a subgroup of patients with ARDS who may benefit the most of PP.
authors: Intensive Care Unit and Transplantation Department (DAR B), Saint Eloi Hospital, University Hospital of Montpellier-INSERM U1046, France.
authors: Audrey
authors: A
authors: De Jong
authors: Medical and Informatic Department, Lapeyronie University Hospital of Montpellier, UMR 729 MISTEA, Route de Ganges, Montpellier cedex 5, France.
authors: Nicolas
authors: N
authors: Molinari
authors: Intensive Care Unit and Transplantation Department (DAR B), Saint Eloi Hospital, University Hospital of Montpellier-INSERM U1046, France.
authors: Mustapha
authors: M
authors: Sebbane
authors: Intensive Care Unit and Transplantation Department (DAR B), Saint Eloi Hospital, University Hospital of Montpellier-INSERM U1046, France.
authors: Albert
authors: A
authors: Prades
authors: Intensive Care Unit and Transplantation Department (DAR B), Saint Eloi Hospital, University Hospital of Montpellier-INSERM U1046, France.
authors: Emmanuel
authors: E
authors: Futier
authors: Intensive Care Unit and Transplantation Department (DAR B), Saint Eloi Hospital, University Hospital of Montpellier-INSERM U1046, France.
authors: Boris
authors: B
authors: Jung
authors: Intensive Care Unit and Transplantation Department (DAR B), Saint Eloi Hospital, University Hospital of Montpellier-INSERM U1046, France.
authors: Gérald
authors: G
authors: Chanques
authors: Intensive Care Unit and Transplantation Department (DAR B), Saint Eloi Hospital, University Hospital of Montpellier-INSERM U1046, France. Electronic address: s-jaber@chu-montpellier.fr.
authors: Samir
authors: S
authors: Jaber
mesh_terms: D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000453:epidemiology; D023381:Endpoint Determination; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000503:physiopathology; D016684:Prone Position; D016016:Proportional Hazards Models; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric