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An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
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Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial

Rafael Fernandez1, Xavier Trenchs, Jordi Klamburg

  • 1CIBER Enfermedades Respiratorias, Hospital de Sabadell, Parc Taulis/n, 08208, Sabadell, Spain. rfernandez@tauli.cat

Intensive Care Medicine
|April 23, 2008
PubMed

Insights

Early and continuous prone positioning in Acute Respiratory Distress Syndrome (ARDS) patients showed a trend toward improved survival. This intervention, applied early with protective ventilation, demonstrated minimal side effects and enhanced oxygenation.

Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology
  • Clinical Trials

Background:

  • Acute Respiratory Distress Syndrome (ARDS) presents significant mortality challenges.
  • Protective ventilation strategies are standard for ARDS management.
  • The role of early, continuous prone positioning in refractory ARDS requires further investigation.

Purpose of the Study:

  • To evaluate the impact of early and continuous prone positioning on survival in ARDS patients receiving protective ventilation.
  • To assess the effects of prone positioning on oxygenation, respiratory mechanics, and clinical outcomes.

Main Methods:

  • An open randomized controlled trial was conducted across 17 medical-surgical ICUs.
  • Forty mechanically ventilated patients with early, refractory ARDS were randomized to supine or early (within 48 hours), continuous (>= 20 hours/day) prone positioning.
  • The study was stopped prematurely due to slow patient recruitment.

Main Results:

  • Prone positioning showed a trend toward improved PaO(2)/FIO(2) ratios, reaching statistical significance on day 3 (234 vs. 159 mmHg).
  • Sixty-day survival in the prone group was 62% compared to 47% in the supine group, indicating a potential benefit.
  • Prone positioning was associated with minimal and reversible side effects.

Conclusions:

  • Early and continuous prone positioning may offer a survival benefit for ARDS patients.
  • The findings support further research into prone positioning as an adjunctive therapy for ARDS.
  • Despite premature termination, the study provides valuable data on the efficacy and safety of early prone positioning.
Abstract

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