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Effect of prone positioning on the survival of patients with acute respiratory failure.
N Engl J Med. 2001 Aug 23; 345(8):568-73.NEJM

Abstract

BACKGROUND

Although placing patients with acute respiratory failure in a prone (face down) position improves their oxygenation 60 to 70 percent of the time, the effect on survival is not known.

METHODS

In a multicenter, randomized trial, we compared conventional treatment (in the supine position) of patients with acute lung injury or the acute respiratory distress syndrome with a predefined strategy of placing patients in a prone position for six or more hours daily for 10 days. We enrolled 304 patients, 152 in each group.

RESULTS

The mortality rate was 23.0 percent during the 10-day study period, 49.3 percent at the time of discharge from the intensive care unit, and 60.5 percent at 6 months. The relative risk of death in the prone group as compared with the supine group was 0.84 at the end of the study period (95 percent confidence interval, 0.56 to 1.27), 1.05 at the time of discharge from the intensive care unit (95 percent confidence interval, 0.84 to 1.32), and 1.06 at six months (95 percent confidence interval, 0.88 to 1.28). During the study period the mean (+/-SD) increase in the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen, measured each morning while patients were supine, was greater in the prone than the supine group (63.0+/-66.8 vs. 44.6+/-68.2, P=0.02). The incidence of complications related to positioning (such as pressure sores and accidental extubation) was similar in the two groups.

CONCLUSIONS

Although placing patients with acute respiratory failure in a prone position improves their oxygenation, it does not improve survival.

Authors+Show Affiliations

Istituto di Anestesia e Rianimazione, Università di Milano, Ospedale Maggiore di Milano, Milan, Italy. gattinon@polic.cilea.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11529210

Citation

Gattinoni, L, et al. "Effect of Prone Positioning On the Survival of Patients With Acute Respiratory Failure." The New England Journal of Medicine, vol. 345, no. 8, 2001, pp. 568-73.
Gattinoni L, Tognoni G, Pesenti A, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med. 2001;345(8):568-73.
Gattinoni, L., Tognoni, G., Pesenti, A., Taccone, P., Mascheroni, D., Labarta, V., Malacrida, R., Di Giulio, P., Fumagalli, R., Pelosi, P., Brazzi, L., & Latini, R. (2001). Effect of prone positioning on the survival of patients with acute respiratory failure. The New England Journal of Medicine, 345(8), 568-73.
Gattinoni L, et al. Effect of Prone Positioning On the Survival of Patients With Acute Respiratory Failure. N Engl J Med. 2001 Aug 23;345(8):568-73. PubMed PMID: 11529210.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of prone positioning on the survival of patients with acute respiratory failure. AU - Gattinoni,L, AU - Tognoni,G, AU - Pesenti,A, AU - Taccone,P, AU - Mascheroni,D, AU - Labarta,V, AU - Malacrida,R, AU - Di Giulio,P, AU - Fumagalli,R, AU - Pelosi,P, AU - Brazzi,L, AU - Latini,R, AU - ,, PY - 2001/9/1/pubmed PY - 2001/9/8/medline PY - 2001/9/1/entrez SP - 568 EP - 73 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 345 IS - 8 N2 - BACKGROUND: Although placing patients with acute respiratory failure in a prone (face down) position improves their oxygenation 60 to 70 percent of the time, the effect on survival is not known. METHODS: In a multicenter, randomized trial, we compared conventional treatment (in the supine position) of patients with acute lung injury or the acute respiratory distress syndrome with a predefined strategy of placing patients in a prone position for six or more hours daily for 10 days. We enrolled 304 patients, 152 in each group. RESULTS: The mortality rate was 23.0 percent during the 10-day study period, 49.3 percent at the time of discharge from the intensive care unit, and 60.5 percent at 6 months. The relative risk of death in the prone group as compared with the supine group was 0.84 at the end of the study period (95 percent confidence interval, 0.56 to 1.27), 1.05 at the time of discharge from the intensive care unit (95 percent confidence interval, 0.84 to 1.32), and 1.06 at six months (95 percent confidence interval, 0.88 to 1.28). During the study period the mean (+/-SD) increase in the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen, measured each morning while patients were supine, was greater in the prone than the supine group (63.0+/-66.8 vs. 44.6+/-68.2, P=0.02). The incidence of complications related to positioning (such as pressure sores and accidental extubation) was similar in the two groups. CONCLUSIONS: Although placing patients with acute respiratory failure in a prone position improves their oxygenation, it does not improve survival. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/11529210/Effect_of_prone_positioning_on_the_survival_of_patients_with_acute_respiratory_failure_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa010043?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -