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Patient Outcome

Survival

Five large trials (Table 6.1) have been performed over the last 15 years comparing prone position to supine position, and the results on patient survival can be summarized as follows. First, the mortality was significantly only reduced in patients with the highest severity of hypoxemia (PaO2/FiO2 <100 mmHg) as demonstrated in a patients’ data meta-analysis [9]. Second, this was confirmed in a single trial in select ARDS patients with moderate to severe ARDS (PaO2/FiO2 <150 mmHg and PEEP of 5 cmH2O or more and FiO2 of 0.6 or more at the time of inclusion) after a 12-24-h stabilization period. Third, subsequent meta-analysis suggested that

Table 6.1 Main characteristics of five large multicenter prospective randomized trials comparing prone to supine position in ARDS patients

Trial (first author and acronym)

Gattinoni PS I [32]

Guerin DDDV [33]

Mancebo

[20]

Taccone PS II [34]

Guerin

PROSEVA

[21]

n patients (SP/PP groups)

152/152

378/413

60/76

174/168

229/237

% of ARDS (SP/PP groups)

93.3/94.7

28/33.9

100/100

100/100

100/100

PaO2/FiO2 (mmHg) at the time of randomization

127

150

147

113

100

Tidal volume (mL/ kg) at the time of randomization

10.3

MBW

8

MBW

8.4

PBW

8

PBW

6.1

PBW

PEEP at the time of randomization (cmH2O)

10

8

12

10

10

PP session duration (average hours per session)

7

8

17

18

17

Mortality (SP/PP groups) (%)

25.0/21.1

31.5/32.4

58.0/43.0

32.8/31.0

32.8/16.0a

SP Supine position, PP Prone position, PEEP Positive end-expiratory pressure, MBW Measured body weight, PBW Predicted body weight from gender and height aP < 0.001

benefit of proning on survival was associated with length of proning sessions, lung protective ventilation, and intensity of hypoxemia [35].

 
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