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Prone positioning in severe acute respiratory distress syndrome.
N Engl J Med. 2013 Jun 06; 368(23):2159-68.NEJM

Abstract

BACKGROUND

Previous trials involving patients with the acute respiratory distress syndrome (ARDS) have failed to show a beneficial effect of prone positioning during mechanical ventilatory support on outcomes. We evaluated the effect of early application of prone positioning on outcomes in patients with severe ARDS.

METHODS

In this multicenter, prospective, randomized, controlled trial, we randomly assigned 466 patients with severe ARDS to undergo prone-positioning sessions of at least 16 hours or to be left in the supine position. Severe ARDS was defined as a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (FiO2) of less than 150 mm Hg, with an FiO2 of at least 0.6, a positive end-expiratory pressure of at least 5 cm of water, and a tidal volume close to 6 ml per kilogram of predicted body weight. The primary outcome was the proportion of patients who died from any cause within 28 days after inclusion.

RESULTS

A total of 237 patients were assigned to the prone group, and 229 patients were assigned to the supine group. The 28-day mortality was 16.0% in the prone group and 32.8% in the supine group (P<0.001). The hazard ratio for death with prone positioning was 0.39 (95% confidence interval [CI], 0.25 to 0.63). Unadjusted 90-day mortality was 23.6% in the prone group versus 41.0% in the supine group (P<0.001), with a hazard ratio of 0.44 (95% CI, 0.29 to 0.67). The incidence of complications did not differ significantly between the groups, except for the incidence of cardiac arrests, which was higher in the supine group.

CONCLUSIONS

In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality. (Funded by the Programme Hospitalier de Recherche Clinique National 2006 and 2010 of the French Ministry of Health; PROSEVA ClinicalTrials.gov number, NCT00527813.).

Authors+Show Affiliations

Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon; Université de Lyon; and Creatis INSERM 1044, Lyon, France. claude.guerin@chu-lyon.frNo 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 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 availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

23688302

Citation

Guérin, Claude, et al. "Prone Positioning in Severe Acute Respiratory Distress Syndrome." The New England Journal of Medicine, vol. 368, no. 23, 2013, pp. 2159-68.
Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159-68.
Guérin, C., Reignier, J., Richard, J. C., Beuret, P., Gacouin, A., Boulain, T., Mercier, E., Badet, M., Mercat, A., Baudin, O., Clavel, M., Chatellier, D., Jaber, S., Rosselli, S., Mancebo, J., Sirodot, M., Hilbert, G., Bengler, C., Richecoeur, J., ... Ayzac, L. (2013). Prone positioning in severe acute respiratory distress syndrome. The New England Journal of Medicine, 368(23), 2159-68. https://doi.org/10.1056/NEJMoa1214103
Guérin C, et al. Prone Positioning in Severe Acute Respiratory Distress Syndrome. N Engl J Med. 2013 Jun 6;368(23):2159-68. PubMed PMID: 23688302.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prone positioning in severe acute respiratory distress syndrome. AU - Guérin,Claude, AU - Reignier,Jean, AU - Richard,Jean-Christophe, AU - Beuret,Pascal, AU - Gacouin,Arnaud, AU - Boulain,Thierry, AU - Mercier,Emmanuelle, AU - Badet,Michel, AU - Mercat,Alain, AU - Baudin,Olivier, AU - Clavel,Marc, AU - Chatellier,Delphine, AU - Jaber,Samir, AU - Rosselli,Sylvène, AU - Mancebo,Jordi, AU - Sirodot,Michel, AU - Hilbert,Gilles, AU - Bengler,Christian, AU - Richecoeur,Jack, AU - Gainnier,Marc, AU - Bayle,Frédérique, AU - Bourdin,Gael, AU - Leray,Véronique, AU - Girard,Raphaele, AU - Baboi,Loredana, AU - Ayzac,Louis, AU - ,, Y1 - 2013/05/20/ PY - 2013/5/22/entrez PY - 2013/5/22/pubmed PY - 2013/6/12/medline SP - 2159 EP - 68 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 368 IS - 23 N2 - BACKGROUND: Previous trials involving patients with the acute respiratory distress syndrome (ARDS) have failed to show a beneficial effect of prone positioning during mechanical ventilatory support on outcomes. We evaluated the effect of early application of prone positioning on outcomes in patients with severe ARDS. METHODS: In this multicenter, prospective, randomized, controlled trial, we randomly assigned 466 patients with severe ARDS to undergo prone-positioning sessions of at least 16 hours or to be left in the supine position. Severe ARDS was defined as a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (FiO2) of less than 150 mm Hg, with an FiO2 of at least 0.6, a positive end-expiratory pressure of at least 5 cm of water, and a tidal volume close to 6 ml per kilogram of predicted body weight. The primary outcome was the proportion of patients who died from any cause within 28 days after inclusion. RESULTS: A total of 237 patients were assigned to the prone group, and 229 patients were assigned to the supine group. The 28-day mortality was 16.0% in the prone group and 32.8% in the supine group (P<0.001). The hazard ratio for death with prone positioning was 0.39 (95% confidence interval [CI], 0.25 to 0.63). Unadjusted 90-day mortality was 23.6% in the prone group versus 41.0% in the supine group (P<0.001), with a hazard ratio of 0.44 (95% CI, 0.29 to 0.67). The incidence of complications did not differ significantly between the groups, except for the incidence of cardiac arrests, which was higher in the supine group. CONCLUSIONS: In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality. (Funded by the Programme Hospitalier de Recherche Clinique National 2006 and 2010 of the French Ministry of Health; PROSEVA ClinicalTrials.gov number, NCT00527813.). SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/23688302/full_citation L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa1214103?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -