Effects of Systematic Prone Positioning in Hypoxemic Acute Respiratory Failure: A Randomized Controlled Trial
CONTEXT A recent trial showed that placing patients with acute lung injury in the prone position did not increase survival; however, whether those results hold true for patients with hypoxemic acute respiratory failure (ARF) is unclear. OBJECTIVE To determine whether prone positioning improves morta...
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2004-11, Vol.292 (19), p.2379-2387 |
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| creator | Guerin, Claude Gaillard, Sandrine Lemasson, Stephane Ayzac, Louis Girard, Raphaele Beuret, Pascal Palmier, Bruno Le, Quoc Viet Sirodot, Michel Rosselli, Sylvaine Cadiergue, Vincent Sainty, Jean-Marie Barbe, Philippe Combourieu, Emmanuel Debatty, Daniel Rouffineau, Jean Ezingeard, Eric Millet, Olivier Guelon, Dominique Rodriguez, Luc Martin, Olivier Renault, Anne Sibille, Jean-Paul Kaidomar, Michel |
| description | CONTEXT A recent trial showed that placing patients with acute lung injury in
the prone position did not increase survival; however, whether those results
hold true for patients with hypoxemic acute respiratory failure (ARF) is unclear. OBJECTIVE To determine whether prone positioning improves mortality in ARF patients. DESIGN, SETTING, AND PATIENTS Prospective, unblinded, multicenter controlled trial of 791 ARF patients
in 21 general intensive care units in France using concealed randomization
conducted from December 14, 1998, through December 31, 2002. To be included,
patients had to be at least 18 years, hemodynamically stable, receiving mechanical
ventilation, and intubated and had to have a partial pressure of arterial
oxygen (PaO2) to fraction of inspired oxygen (FIO2) ratio of 300 or less and no contraindications to lying
prone. INTERVENTIONS Patients were randomly assigned to prone position placement (n = 413),
applied as early as possible for at least 8 hours per day on standard beds,
or to supine position placement (n = 378). MAIN OUTCOME MEASURES The primary end point was 28-day mortality; secondary end points were
90-day mortality, duration of mechanical ventilation, incidence of ventilator-associated
pneumonia (VAP), and oxygenation. RESULTS The 2 groups were comparable at randomization. The 28-day mortality
rate was 32.4% for the prone group and 31.5% for the supine group (relative
risk [RR], 0.97; 95% confidence interval [CI], 0.79-1.19; P = .77). Ninety-day mortality for the prone group was 43.3%
vs 42.2% for the supine group (RR, 0.98; 95% CI, 0.84-1.13; P = .74). The mean (SD) duration of mechanical ventilation
was 13.7 (7.8) days for the prone group vs 14.1 (8.6) days for the supine
group (P = .93) and the VAP incidence was
1.66 vs 2.14 episodes per 100-patients days of intubation, respectively (P = .045). The PaO2/FIO2 ratio was significantly higher in the prone group during
the 28-day follow-up. However, pressure sores, selective intubation, and endotracheal
tube obstruction incidences were higher in the prone group. CONCLUSIONS This trial demonstrated no beneficial outcomes and some safety concerns
associated with prone positioning. For patients with hypoxemic ARF, prone
position placement may lower the incidence of VAP. |
| doi_str_mv | 10.1001/jama.292.19.2379 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_67081523</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>199785</ama_id><sourcerecordid>740712031</sourcerecordid><originalsourceid>FETCH-LOGICAL-a197t-67aa575d27155d63632223a0d6665933c6dc6c9763ba77ac532a9783a2fc7ef03</originalsourceid><addsrcrecordid>eNpd0U1rGzEQBmARWhon7T29FBFIb-vqw5JWuRljN4FAjeuel7FWG2R2JVfSQtxfX4EdAtFlBPMwvMwgdEPJlBJCf-xhgCnTbEr1lHGlL9CECl5XXOj6A5oQoutKzerZJbpKaU_Ko1x9QpdUiJmiUk7QsOw6a3LCocO_jynbAbIzeB2Dt3gdkssueOefsfP44XgIL3Yo7bkZs8Ubmw4uQg7xiFfg-jHaezzHG_BtGNw_2-JF8DmGvi_fbXTQf0YfO-iT_XKu1-jParldPFRPv34-LuZPFVCtciUVgFCiZaoEbSWXnDHGgbRSSqE5N7I10mgl-Q6UAiM4A61qDqwzynaEX6Pvp7mHGP6ONuVmcMnYvgdvw5gaqUhNBeMF3r6D-zBGX7I1jFJeQtS6oG9nNO4G2zaH6AaIx-Z1iwXcnQEkA30XwRuX3pxkUtCaFff15MrZ3rq6RBf8P4aoiTI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211357589</pqid></control><display><type>article</type><title>Effects of Systematic Prone Positioning in Hypoxemic Acute Respiratory Failure: A Randomized Controlled Trial</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Guerin, Claude ; Gaillard, Sandrine ; Lemasson, Stephane ; Ayzac, Louis ; Girard, Raphaele ; Beuret, Pascal ; Palmier, Bruno ; Le, Quoc Viet ; Sirodot, Michel ; Rosselli, Sylvaine ; Cadiergue, Vincent ; Sainty, Jean-Marie ; Barbe, Philippe ; Combourieu, Emmanuel ; Debatty, Daniel ; Rouffineau, Jean ; Ezingeard, Eric ; Millet, Olivier ; Guelon, Dominique ; Rodriguez, Luc ; Martin, Olivier ; Renault, Anne ; Sibille, Jean-Paul ; Kaidomar, Michel</creator><creatorcontrib>Guerin, Claude ; Gaillard, Sandrine ; Lemasson, Stephane ; Ayzac, Louis ; Girard, Raphaele ; Beuret, Pascal ; Palmier, Bruno ; Le, Quoc Viet ; Sirodot, Michel ; Rosselli, Sylvaine ; Cadiergue, Vincent ; Sainty, Jean-Marie ; Barbe, Philippe ; Combourieu, Emmanuel ; Debatty, Daniel ; Rouffineau, Jean ; Ezingeard, Eric ; Millet, Olivier ; Guelon, Dominique ; Rodriguez, Luc ; Martin, Olivier ; Renault, Anne ; Sibille, Jean-Paul ; Kaidomar, Michel</creatorcontrib><description>CONTEXT A recent trial showed that placing patients with acute lung injury in
the prone position did not increase survival; however, whether those results
hold true for patients with hypoxemic acute respiratory failure (ARF) is unclear. OBJECTIVE To determine whether prone positioning improves mortality in ARF patients. DESIGN, SETTING, AND PATIENTS Prospective, unblinded, multicenter controlled trial of 791 ARF patients
in 21 general intensive care units in France using concealed randomization
conducted from December 14, 1998, through December 31, 2002. To be included,
patients had to be at least 18 years, hemodynamically stable, receiving mechanical
ventilation, and intubated and had to have a partial pressure of arterial
oxygen (PaO2) to fraction of inspired oxygen (FIO2) ratio of 300 or less and no contraindications to lying
prone. INTERVENTIONS Patients were randomly assigned to prone position placement (n = 413),
applied as early as possible for at least 8 hours per day on standard beds,
or to supine position placement (n = 378). MAIN OUTCOME MEASURES The primary end point was 28-day mortality; secondary end points were
90-day mortality, duration of mechanical ventilation, incidence of ventilator-associated
pneumonia (VAP), and oxygenation. RESULTS The 2 groups were comparable at randomization. The 28-day mortality
rate was 32.4% for the prone group and 31.5% for the supine group (relative
risk [RR], 0.97; 95% confidence interval [CI], 0.79-1.19; P = .77). Ninety-day mortality for the prone group was 43.3%
vs 42.2% for the supine group (RR, 0.98; 95% CI, 0.84-1.13; P = .74). The mean (SD) duration of mechanical ventilation
was 13.7 (7.8) days for the prone group vs 14.1 (8.6) days for the supine
group (P = .93) and the VAP incidence was
1.66 vs 2.14 episodes per 100-patients days of intubation, respectively (P = .045). The PaO2/FIO2 ratio was significantly higher in the prone group during
the 28-day follow-up. However, pressure sores, selective intubation, and endotracheal
tube obstruction incidences were higher in the prone group. CONCLUSIONS This trial demonstrated no beneficial outcomes and some safety concerns
associated with prone positioning. For patients with hypoxemic ARF, prone
position placement may lower the incidence of VAP.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.292.19.2379</identifier><identifier>PMID: 15547166</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Acute Disease ; Aged ; Biological and medical sciences ; Clinical outcomes ; Female ; General aspects ; Humans ; Hypoxia - therapy ; Intubation, Intratracheal ; Male ; Medical procedures ; Medical sciences ; Middle Aged ; Mortality ; Pneumology ; Pneumonia - etiology ; Prone Position ; Prospective Studies ; Respiration, Artificial - adverse effects ; Respiratory diseases ; Respiratory Insufficiency - complications ; Respiratory Insufficiency - therapy ; Respiratory system : syndromes and miscellaneous diseases ; Risk ; Supine Position ; Survival Analysis</subject><ispartof>JAMA : the journal of the American Medical Association, 2004-11, Vol.292 (19), p.2379-2387</ispartof><rights>2004 INIST-CNRS</rights><rights>Copyright American Medical Association Nov 17, 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.292.19.2379$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.292.19.2379$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,780,784,3340,27924,27925,76489,76492</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16265182$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15547166$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Guerin, Claude</creatorcontrib><creatorcontrib>Gaillard, Sandrine</creatorcontrib><creatorcontrib>Lemasson, Stephane</creatorcontrib><creatorcontrib>Ayzac, Louis</creatorcontrib><creatorcontrib>Girard, Raphaele</creatorcontrib><creatorcontrib>Beuret, Pascal</creatorcontrib><creatorcontrib>Palmier, Bruno</creatorcontrib><creatorcontrib>Le, Quoc Viet</creatorcontrib><creatorcontrib>Sirodot, Michel</creatorcontrib><creatorcontrib>Rosselli, Sylvaine</creatorcontrib><creatorcontrib>Cadiergue, Vincent</creatorcontrib><creatorcontrib>Sainty, Jean-Marie</creatorcontrib><creatorcontrib>Barbe, Philippe</creatorcontrib><creatorcontrib>Combourieu, Emmanuel</creatorcontrib><creatorcontrib>Debatty, Daniel</creatorcontrib><creatorcontrib>Rouffineau, Jean</creatorcontrib><creatorcontrib>Ezingeard, Eric</creatorcontrib><creatorcontrib>Millet, Olivier</creatorcontrib><creatorcontrib>Guelon, Dominique</creatorcontrib><creatorcontrib>Rodriguez, Luc</creatorcontrib><creatorcontrib>Martin, Olivier</creatorcontrib><creatorcontrib>Renault, Anne</creatorcontrib><creatorcontrib>Sibille, Jean-Paul</creatorcontrib><creatorcontrib>Kaidomar, Michel</creatorcontrib><title>Effects of Systematic Prone Positioning in Hypoxemic Acute Respiratory Failure: A Randomized Controlled Trial</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>CONTEXT A recent trial showed that placing patients with acute lung injury in
the prone position did not increase survival; however, whether those results
hold true for patients with hypoxemic acute respiratory failure (ARF) is unclear. OBJECTIVE To determine whether prone positioning improves mortality in ARF patients. DESIGN, SETTING, AND PATIENTS Prospective, unblinded, multicenter controlled trial of 791 ARF patients
in 21 general intensive care units in France using concealed randomization
conducted from December 14, 1998, through December 31, 2002. To be included,
patients had to be at least 18 years, hemodynamically stable, receiving mechanical
ventilation, and intubated and had to have a partial pressure of arterial
oxygen (PaO2) to fraction of inspired oxygen (FIO2) ratio of 300 or less and no contraindications to lying
prone. INTERVENTIONS Patients were randomly assigned to prone position placement (n = 413),
applied as early as possible for at least 8 hours per day on standard beds,
or to supine position placement (n = 378). MAIN OUTCOME MEASURES The primary end point was 28-day mortality; secondary end points were
90-day mortality, duration of mechanical ventilation, incidence of ventilator-associated
pneumonia (VAP), and oxygenation. RESULTS The 2 groups were comparable at randomization. The 28-day mortality
rate was 32.4% for the prone group and 31.5% for the supine group (relative
risk [RR], 0.97; 95% confidence interval [CI], 0.79-1.19; P = .77). Ninety-day mortality for the prone group was 43.3%
vs 42.2% for the supine group (RR, 0.98; 95% CI, 0.84-1.13; P = .74). The mean (SD) duration of mechanical ventilation
was 13.7 (7.8) days for the prone group vs 14.1 (8.6) days for the supine
group (P = .93) and the VAP incidence was
1.66 vs 2.14 episodes per 100-patients days of intubation, respectively (P = .045). The PaO2/FIO2 ratio was significantly higher in the prone group during
the 28-day follow-up. However, pressure sores, selective intubation, and endotracheal
tube obstruction incidences were higher in the prone group. CONCLUSIONS This trial demonstrated no beneficial outcomes and some safety concerns
associated with prone positioning. For patients with hypoxemic ARF, prone
position placement may lower the incidence of VAP.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Clinical outcomes</subject><subject>Female</subject><subject>General aspects</subject><subject>Humans</subject><subject>Hypoxia - therapy</subject><subject>Intubation, Intratracheal</subject><subject>Male</subject><subject>Medical procedures</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Pneumology</subject><subject>Pneumonia - etiology</subject><subject>Prone Position</subject><subject>Prospective Studies</subject><subject>Respiration, Artificial - adverse effects</subject><subject>Respiratory diseases</subject><subject>Respiratory Insufficiency - complications</subject><subject>Respiratory Insufficiency - therapy</subject><subject>Respiratory system : syndromes and miscellaneous diseases</subject><subject>Risk</subject><subject>Supine Position</subject><subject>Survival Analysis</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0U1rGzEQBmARWhon7T29FBFIb-vqw5JWuRljN4FAjeuel7FWG2R2JVfSQtxfX4EdAtFlBPMwvMwgdEPJlBJCf-xhgCnTbEr1lHGlL9CECl5XXOj6A5oQoutKzerZJbpKaU_Ko1x9QpdUiJmiUk7QsOw6a3LCocO_jynbAbIzeB2Dt3gdkssueOefsfP44XgIL3Yo7bkZs8Ubmw4uQg7xiFfg-jHaezzHG_BtGNw_2-JF8DmGvi_fbXTQf0YfO-iT_XKu1-jParldPFRPv34-LuZPFVCtciUVgFCiZaoEbSWXnDHGgbRSSqE5N7I10mgl-Q6UAiM4A61qDqwzynaEX6Pvp7mHGP6ONuVmcMnYvgdvw5gaqUhNBeMF3r6D-zBGX7I1jFJeQtS6oG9nNO4G2zaH6AaIx-Z1iwXcnQEkA30XwRuX3pxkUtCaFff15MrZ3rq6RBf8P4aoiTI</recordid><startdate>20041117</startdate><enddate>20041117</enddate><creator>Guerin, Claude</creator><creator>Gaillard, Sandrine</creator><creator>Lemasson, Stephane</creator><creator>Ayzac, Louis</creator><creator>Girard, Raphaele</creator><creator>Beuret, Pascal</creator><creator>Palmier, Bruno</creator><creator>Le, Quoc Viet</creator><creator>Sirodot, Michel</creator><creator>Rosselli, Sylvaine</creator><creator>Cadiergue, Vincent</creator><creator>Sainty, Jean-Marie</creator><creator>Barbe, Philippe</creator><creator>Combourieu, Emmanuel</creator><creator>Debatty, Daniel</creator><creator>Rouffineau, Jean</creator><creator>Ezingeard, Eric</creator><creator>Millet, Olivier</creator><creator>Guelon, Dominique</creator><creator>Rodriguez, Luc</creator><creator>Martin, Olivier</creator><creator>Renault, Anne</creator><creator>Sibille, Jean-Paul</creator><creator>Kaidomar, Michel</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>20041117</creationdate><title>Effects of Systematic Prone Positioning in Hypoxemic Acute Respiratory Failure: A Randomized Controlled Trial</title><author>Guerin, Claude ; Gaillard, Sandrine ; Lemasson, Stephane ; Ayzac, Louis ; Girard, Raphaele ; Beuret, Pascal ; Palmier, Bruno ; Le, Quoc Viet ; Sirodot, Michel ; Rosselli, Sylvaine ; Cadiergue, Vincent ; Sainty, Jean-Marie ; Barbe, Philippe ; Combourieu, Emmanuel ; Debatty, Daniel ; Rouffineau, Jean ; Ezingeard, Eric ; Millet, Olivier ; Guelon, Dominique ; Rodriguez, Luc ; Martin, Olivier ; Renault, Anne ; Sibille, Jean-Paul ; Kaidomar, Michel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a197t-67aa575d27155d63632223a0d6665933c6dc6c9763ba77ac532a9783a2fc7ef03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Acute Disease</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Clinical outcomes</topic><topic>Female</topic><topic>General aspects</topic><topic>Humans</topic><topic>Hypoxia - therapy</topic><topic>Intubation, Intratracheal</topic><topic>Male</topic><topic>Medical procedures</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Pneumology</topic><topic>Pneumonia - etiology</topic><topic>Prone Position</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial - adverse effects</topic><topic>Respiratory diseases</topic><topic>Respiratory Insufficiency - complications</topic><topic>Respiratory Insufficiency - therapy</topic><topic>Respiratory system : syndromes and miscellaneous diseases</topic><topic>Risk</topic><topic>Supine Position</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Guerin, Claude</creatorcontrib><creatorcontrib>Gaillard, Sandrine</creatorcontrib><creatorcontrib>Lemasson, Stephane</creatorcontrib><creatorcontrib>Ayzac, Louis</creatorcontrib><creatorcontrib>Girard, Raphaele</creatorcontrib><creatorcontrib>Beuret, Pascal</creatorcontrib><creatorcontrib>Palmier, Bruno</creatorcontrib><creatorcontrib>Le, Quoc Viet</creatorcontrib><creatorcontrib>Sirodot, Michel</creatorcontrib><creatorcontrib>Rosselli, Sylvaine</creatorcontrib><creatorcontrib>Cadiergue, Vincent</creatorcontrib><creatorcontrib>Sainty, Jean-Marie</creatorcontrib><creatorcontrib>Barbe, Philippe</creatorcontrib><creatorcontrib>Combourieu, Emmanuel</creatorcontrib><creatorcontrib>Debatty, Daniel</creatorcontrib><creatorcontrib>Rouffineau, Jean</creatorcontrib><creatorcontrib>Ezingeard, Eric</creatorcontrib><creatorcontrib>Millet, Olivier</creatorcontrib><creatorcontrib>Guelon, Dominique</creatorcontrib><creatorcontrib>Rodriguez, Luc</creatorcontrib><creatorcontrib>Martin, Olivier</creatorcontrib><creatorcontrib>Renault, Anne</creatorcontrib><creatorcontrib>Sibille, Jean-Paul</creatorcontrib><creatorcontrib>Kaidomar, Michel</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Guerin, Claude</au><au>Gaillard, Sandrine</au><au>Lemasson, Stephane</au><au>Ayzac, Louis</au><au>Girard, Raphaele</au><au>Beuret, Pascal</au><au>Palmier, Bruno</au><au>Le, Quoc Viet</au><au>Sirodot, Michel</au><au>Rosselli, Sylvaine</au><au>Cadiergue, Vincent</au><au>Sainty, Jean-Marie</au><au>Barbe, Philippe</au><au>Combourieu, Emmanuel</au><au>Debatty, Daniel</au><au>Rouffineau, Jean</au><au>Ezingeard, Eric</au><au>Millet, Olivier</au><au>Guelon, Dominique</au><au>Rodriguez, Luc</au><au>Martin, Olivier</au><au>Renault, Anne</au><au>Sibille, Jean-Paul</au><au>Kaidomar, Michel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of Systematic Prone Positioning in Hypoxemic Acute Respiratory Failure: A Randomized Controlled Trial</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2004-11-17</date><risdate>2004</risdate><volume>292</volume><issue>19</issue><spage>2379</spage><epage>2387</epage><pages>2379-2387</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>CONTEXT A recent trial showed that placing patients with acute lung injury in
the prone position did not increase survival; however, whether those results
hold true for patients with hypoxemic acute respiratory failure (ARF) is unclear. OBJECTIVE To determine whether prone positioning improves mortality in ARF patients. DESIGN, SETTING, AND PATIENTS Prospective, unblinded, multicenter controlled trial of 791 ARF patients
in 21 general intensive care units in France using concealed randomization
conducted from December 14, 1998, through December 31, 2002. To be included,
patients had to be at least 18 years, hemodynamically stable, receiving mechanical
ventilation, and intubated and had to have a partial pressure of arterial
oxygen (PaO2) to fraction of inspired oxygen (FIO2) ratio of 300 or less and no contraindications to lying
prone. INTERVENTIONS Patients were randomly assigned to prone position placement (n = 413),
applied as early as possible for at least 8 hours per day on standard beds,
or to supine position placement (n = 378). MAIN OUTCOME MEASURES The primary end point was 28-day mortality; secondary end points were
90-day mortality, duration of mechanical ventilation, incidence of ventilator-associated
pneumonia (VAP), and oxygenation. RESULTS The 2 groups were comparable at randomization. The 28-day mortality
rate was 32.4% for the prone group and 31.5% for the supine group (relative
risk [RR], 0.97; 95% confidence interval [CI], 0.79-1.19; P = .77). Ninety-day mortality for the prone group was 43.3%
vs 42.2% for the supine group (RR, 0.98; 95% CI, 0.84-1.13; P = .74). The mean (SD) duration of mechanical ventilation
was 13.7 (7.8) days for the prone group vs 14.1 (8.6) days for the supine
group (P = .93) and the VAP incidence was
1.66 vs 2.14 episodes per 100-patients days of intubation, respectively (P = .045). The PaO2/FIO2 ratio was significantly higher in the prone group during
the 28-day follow-up. However, pressure sores, selective intubation, and endotracheal
tube obstruction incidences were higher in the prone group. CONCLUSIONS This trial demonstrated no beneficial outcomes and some safety concerns
associated with prone positioning. For patients with hypoxemic ARF, prone
position placement may lower the incidence of VAP.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>15547166</pmid><doi>10.1001/jama.292.19.2379</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 2004-11, Vol.292 (19), p.2379-2387 |
| issn | 0098-7484 1538-3598 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_67081523 |
| source | MEDLINE; American Medical Association Journals |
| subjects | Acute Disease Aged Biological and medical sciences Clinical outcomes Female General aspects Humans Hypoxia - therapy Intubation, Intratracheal Male Medical procedures Medical sciences Middle Aged Mortality Pneumology Pneumonia - etiology Prone Position Prospective Studies Respiration, Artificial - adverse effects Respiratory diseases Respiratory Insufficiency - complications Respiratory Insufficiency - therapy Respiratory system : syndromes and miscellaneous diseases Risk Supine Position Survival Analysis |
| title | Effects of Systematic Prone Positioning in Hypoxemic Acute Respiratory Failure: A Randomized Controlled Trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-23T06%3A14%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effects%20of%20Systematic%20Prone%20Positioning%20in%20Hypoxemic%20Acute%20Respiratory%20Failure:%20A%20Randomized%20Controlled%20Trial&rft.jtitle=JAMA%20:%20the%20journal%20of%20the%20American%20Medical%20Association&rft.au=Guerin,%20Claude&rft.date=2004-11-17&rft.volume=292&rft.issue=19&rft.spage=2379&rft.epage=2387&rft.pages=2379-2387&rft.issn=0098-7484&rft.eissn=1538-3598&rft.coden=JAMAAP&rft_id=info:doi/10.1001/jama.292.19.2379&rft_dat=%3Cproquest_pubme%3E740712031%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=211357589&rft_id=info:pmid/15547166&rft_ama_id=199785&rfr_iscdi=true |