title: [The effects of prone position ventilation combined with recruitment maneuvers on outcomes in patients with severe acute respiratory distress syndrome].
abstract: OBJECTIVE
  To evaluate the effects of prone position ventilation combined with recruitment maneuvers (RM) on clinical outcomes in patients with severe acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  In this prospective, randomized, controlled trial, we randomly assigned 116 sequential patients with severe ARDS to the intervention group (which undergo prone-positioning with RM sessions of at least 10 hours) or to the control group (which be left in the supine position).
  
  
  RESULTS
  From July 2012 to July 2013, 116 severe ARDS patients sequentially admitted to the critical department of Peking Union Medical College Hospital were enrolled in the study with 60 patients assigned to the control group and 56 patients to the intervention group. No significant difference was found between the two groups in the demographics including the median patient age, sex ratio, initial Acute Physiology and Chronic Health Evaluation II scores, initial pulmonary function and the sources of ARDS. The oxygenation index recorded in the supine position was significantly higher in the intervention group than in the control group since day 3, whereas the positive end-expiratory pressure and fraction of inspired O2 were significantly lower in the intervention group. The plateau pressure and static compliance of the respiratory system were similar in the two groups. The intervention group had shorter length of ICU stay, fewer ventilation days and decreased 28-day mortality than the control group. The tracheotomy ratio and the time to successful extubation were similar in the two groups. No significant difference between the two groups was shown in the incidence of complications, except for the grade 1 pressure sore, which was higher in the intervention group.
  
  
  CONCLUSIONS
  In patients with severe ARDS, application of prolonged prone-positioning with RM sessions significantly improves the clinical outcomes.
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China. Email: Dwliu98@yahoo.com.
authors.forename: Dawei
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Long
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Na
authors.initials: N
authors.lastname: Cui
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Huaiwu
authors.initials: H
authors.lastname: He
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Ding
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Du
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Chen
mesh_terms: D006801:Humans; D011175:Positive-Pressure Respiration; D016684:Prone Position; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000628:therapy*