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Intensive Care Medicine
Published in: Intensive Care Medicine 5/2011

01-05-2011 | Original

Routine prone positioning in patients with severe ARDS: feasibility and impact on prognosis

Authors: Cyril Charron, Koceila Bouferrache, Vincent Caille, Samuel Castro, Philippe Aegerter, Bernard Page, François Jardin, Antoine Vieillard-Baron

Published in: Intensive Care Medicine | Issue 5/2011

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Abstract

Purpose

Since 1997, we have routinely used prone positioning (PP) in patients who have a PaO2/FiO2 below 100 mmHg after 24–48 h of mechanical ventilation and who are ventilated using a low stretch ventilation strategy. We report here the characteristics and prognosis of this subgroup of patients with severe lung injury to illustrate the feasibility, role, and impact of routine PP in acute respiratory distress syndrome (ARDS).

Results

A total of 218 patients were admitted because of ARDS between 1997 and 2009. Of these patients, 57 (26%) were positioned prone because of a PaO2/FiO2 below 100 mmHg after 24–48 h of mechanical ventilation. Age was 51 ± 16 years, PaO2/FiO2 74 ± 19, and PaCO2 54 ± 10 mmHg. The lung injury score was 3.13 ± 0.15. Tidal volume was 7 ± 2 mL/kg, PEEP 5.6 ± 1.2 cmH2O, and plateau pressure 27 ± 3 cmH2O. Prone sessions lasted 18 h/day and 3.4 ± 1.1 sessions were required to obtain an FiO2 below 60%. The 60-day mortality was 19% and death occurred after 12 ± 5 days. The ratio between observed and predicted mortality was 0.43. In patients with a PaO2/FiO2 below 60 mmHg, the 60-day mortality was 28%. Logistic regression analysis showed that among the 218 patients, PP appeared to be protective with an odds ratio of 0.35 [0.16–0.79].

Conclusion

We demonstrate the clinical feasibility of routine PP in patients with a PaO2/FiO2 below 100 mmHg after 24–48 h and suggest that, when combined with a low stretch ventilation strategy, it is protective with a high survival rate.
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Metadata
Title
Routine prone positioning in patients with severe ARDS: feasibility and impact on prognosis
Authors
Cyril Charron
Koceila Bouferrache
Vincent Caille
Samuel Castro
Philippe Aegerter
Bernard Page
François Jardin
Antoine Vieillard-Baron
Publication date
01-05-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 5/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-011-2180-x

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