title: Prone positioning in acute respiratory distress syndrome after abdominal surgery: a multicenter retrospective study : SAPRONADONF (Study of Ards and PRONe position After abDOmiNal surgery in France).
abstract: BACKGROUND
  The recent demonstration of prone position's strong benefit on patient survival has rendered proning a major therapeutic intervention in severe ARDS. Uncertainties remain as to whether or not ARDS patients in the postoperative period of abdominal surgery should be turned prone because of the risk of abdominal complications. Our aim was to investigate the prevalence of surgical complications between patients with and without prone position after abdominal surgery.
  
  
  METHODS
  This study was a multicenter retrospective cohort of patients with ARDS in a context of recent abdominal surgery. Primary outcome was the number of patients who had at least one surgical complication that could be induced or worsened by prone position. Secondary outcomes included effects of prone position on oxygenation. Data from the prone group were compared with those from the supine group (not having undergone at least a prone position session).
  
  
  RESULTS
  Among 98 patients included, 36 (37%) had at least one prone position session. The rate of surgical complications induced or worsened by prone position did not differ between prone and supine groups [respectively, 14 (39%) vs 27 (44%); p = 0.65]. After propensity score application, there was no significant difference between the two groups (OR 0.72 [0.26-2.02], p = 0.54). Revision surgery did not differ between the groups. The first prone session significantly increased PaO2/FiO2ratio from 95 ± 47 to 189 ± 92 mmHg, p < 0.0001.
  
  
  CONCLUSIONS
  Prone position of ARDS patients after abdominal surgery was not associated with an increased rate of surgical complication. Intensivists should not refrain from proning these patients.
authors.affiliation: Medico-Surgical Intensive Care Unit, Hôpital Louis Mourier, AP-HP, 178 rue des Renouillers, 92700, Colombes, France.|Sorbonne Paris Cité, ECEVE UMR 1123, Univ Paris Diderot, 75018, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gaudry
authors.affiliation: Medico-Surgical Intensive Care Unit, Hôpital Louis Mourier, AP-HP, 178 rue des Renouillers, 92700, Colombes, France.|Département d'Anesthésie Réanimation, Hôpital Lariboisière, AP-HP, 75010, Paris, France.|UMR U 1160, Université Paris-Diderot Paris 7, 75010, Paris, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Tuffet
authors.affiliation: Département d'Anesthésie Réanimation, Hôpital Lariboisière, AP-HP, 75010, Paris, France.|UMR U 1160, Université Paris-Diderot Paris 7, 75010, Paris, France.
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Lukaszewicz
authors.affiliation: Département d'Anesthésie Réanimation, Hôpital Bicêtre, AP-HP, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Laplace
authors.affiliation: Medico-Surgical Intensive Care Unit, Hôpital Louis Mourier, AP-HP, 178 rue des Renouillers, 92700, Colombes, France.
authors.forename: Noémie
authors.initials: N
authors.lastname: Zucman
authors.affiliation: Hôpital Lariboisière, Chirurgie digestive et cancérologique, AP-HP, 75010, Paris, France.|UMR U 965, Université Paris-Diderot Paris 7, 75010, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Pocard
authors.affiliation: Hôpital Bicêtre, Chirurgie générale et digestive, AP-HP, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Costaglioli
authors.affiliation: Hôpital Louis Mourier, Chirurgie digestive, AP-HP, 178 rue des Renouillers, 92700, Colombes, France.|UMR 1149, Univ Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Msika
authors.affiliation: Département d'Anesthésie Réanimation, Hôpital Bicêtre, AP-HP, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Duranteau
authors.affiliation: Département d'Anesthésie Réanimation, Hôpital Lariboisière, AP-HP, 75010, Paris, France.|UMR U 1160, Université Paris-Diderot Paris 7, 75010, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
authors.affiliation: Medico-Surgical Intensive Care Unit, Hôpital Louis Mourier, AP-HP, 178 rue des Renouillers, 92700, Colombes, France.|IAME,UMR 1137, INSERM, 75018, Paris, France.|IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Dreyfuss
authors.affiliation: Sorbonne Paris Cité, ECEVE UMR 1123, Univ Paris Diderot, 75018, Paris, France.|Epidemiology and Clinical Research Department, Hôpital Louis Mourier, AP-HP, 178 rue des Renouillers, 92700, Colombes, France.
authors.forename: David
authors.initials: D
authors.lastname: Hajage
authors.affiliation: Medico-Surgical Intensive Care Unit, Hôpital Louis Mourier, AP-HP, 178 rue des Renouillers, 92700, Colombes, France. jean-damien.ricard@aphp.fr.|IAME,UMR 1137, INSERM, 75018, Paris, France. jean-damien.ricard@aphp.fr.|IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France. jean-damien.ricard@aphp.fr.|Service de Réanimation Médicale, 178 rue des Renouillers, 92701, Colombes Cedex, France. jean-damien.ricard@aphp.fr.
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
keywords: ARDS; Mechanical ventilation; Prone position