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Prone position.
Curr Opin Crit Care. 2014 Feb; 20(1):92-7.CO

Abstract

PURPOSE OF REVIEW

Prone position can prevent ventilator-induced lung injury in acute respiratory distress syndrome (ARDS) patients receiving conventional mechanical ventilation and, hence, may have the potential to improve survival from this basis. Even though no single randomized controlled trial has proven benefit on patient outcome until recently, two meta-analyses, one on grouped data and the other on individual data, have shown that patients with PaO2/FIO2 ratio less than 100 mmHg at the time of inclusion did benefit from prone position. As a fifth trial completed recently has shown a significant reduction in mortality in patients with severe and confirmed ARDS from using prone position, the purpose of this review is to revisit prone positioning in ARDS in the light of these new findings.

RECENT FINDINGS

In this trial done in patients with severe ARDS severity criteria (PaO2/FIO2 ratio less than 150 mmHg with positive end expiratory pressure of 5 cmH2O or more, FIO2 of 60% or more and tidal volume around 6 ml/kg predicted body weight) confirmed 12-24 h after the onset of ARDS, the day 28 mortality in the supine group (229 patients) was 32.8 versus 16% in the prone group (237 patients) (P < 0.001). Significant reduction in mortality was confirmed at day 90.

SUMMARY

From the combined results of the two meta-analyses and the last randomized controlled trial, there is a very strong signal to use prone position in patients with severe ARDS, as early as possible and for long sessions.

Authors+Show Affiliations

Réanimation Médicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

24366167

Citation

Guérin, Claude. "Prone Position." Current Opinion in Critical Care, vol. 20, no. 1, 2014, pp. 92-7.
Guérin C. Prone position. Curr Opin Crit Care. 2014;20(1):92-7.
Guérin, C. (2014). Prone position. Current Opinion in Critical Care, 20(1), 92-7. https://doi.org/10.1097/MCC.0000000000000059
Guérin C. Prone Position. Curr Opin Crit Care. 2014;20(1):92-7. PubMed PMID: 24366167.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prone position. A1 - Guérin,Claude, PY - 2013/12/25/entrez PY - 2013/12/25/pubmed PY - 2014/10/25/medline SP - 92 EP - 7 JF - Current opinion in critical care JO - Curr Opin Crit Care VL - 20 IS - 1 N2 - PURPOSE OF REVIEW: Prone position can prevent ventilator-induced lung injury in acute respiratory distress syndrome (ARDS) patients receiving conventional mechanical ventilation and, hence, may have the potential to improve survival from this basis. Even though no single randomized controlled trial has proven benefit on patient outcome until recently, two meta-analyses, one on grouped data and the other on individual data, have shown that patients with PaO2/FIO2 ratio less than 100 mmHg at the time of inclusion did benefit from prone position. As a fifth trial completed recently has shown a significant reduction in mortality in patients with severe and confirmed ARDS from using prone position, the purpose of this review is to revisit prone positioning in ARDS in the light of these new findings. RECENT FINDINGS: In this trial done in patients with severe ARDS severity criteria (PaO2/FIO2 ratio less than 150 mmHg with positive end expiratory pressure of 5 cmH2O or more, FIO2 of 60% or more and tidal volume around 6 ml/kg predicted body weight) confirmed 12-24 h after the onset of ARDS, the day 28 mortality in the supine group (229 patients) was 32.8 versus 16% in the prone group (237 patients) (P < 0.001). Significant reduction in mortality was confirmed at day 90. SUMMARY: From the combined results of the two meta-analyses and the last randomized controlled trial, there is a very strong signal to use prone position in patients with severe ARDS, as early as possible and for long sessions. SN - 1531-7072 UR - https://www.unboundmedicine.com/medline/citation/24366167/Prone_position_ L2 - https://doi.org/10.1097/MCC.0000000000000059 DB - PRIME DP - Unbound Medicine ER -