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01-08-2008 | Brief Report

Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial

Authors: Rafael Fernandez, Xavier Trenchs, Jordi Klamburg, Jon Castedo, Jose Manuel Serrano, Guillermo Besso, Juan Pedro Tirapu, Antonio Santos, Arantxa Mas, Manuel Parraga, Paola Jubert, Fernando Frutos, Jose Manuel Añon, Manuela Garcia, Fernando Rodriguez, Joan Carles Yebenes, Maria Jesus Lopez

Published in: Intensive Care Medicine | Issue 8/2008

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.

Design and setting

Open randomized controlled trial in 17 medical-surgical ICUs.

Patients

Forty mechanically ventilated patients with early and refractory ARDS despite protective ventilation in the supine position.

Interventions

Patients were randomized to remain supine or be moved to early (within 48 h) and continuous (≥ 20 h/day) prone position until recovery or death. The trial was prematurely stopped due to a low patient recruitment rate.

Measurements and 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. PaO₂/FIO₂ tended to be higher in prone than in supine patients after 6 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.

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Title: Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial
Authors: Rafael Fernandez
Xavier Trenchs
Jordi Klamburg
Jon Castedo
Jose Manuel Serrano
Guillermo Besso
Juan Pedro Tirapu
Antonio Santos
Arantxa Mas
Manuel Parraga
Paola Jubert
Fernando Frutos
Jose Manuel Añon
Manuela Garcia
Fernando Rodriguez
Joan Carles Yebenes
Maria Jesus Lopez
Publication date: 01-08-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 8/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1119-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial

Abstract

Objective

Design and setting

Patients

Interventions

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design and setting

Patients

Interventions

Measurements and results

Conclusions

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