Prone positioning in acute respiratory distress syndrome:: a multicenter randomized clinical trial

被引：115

作者：

Fernandez, Rafael ^{[1
]}

Trenchs, Xavier ^{[2
]}

Klamburg, Jordi ^{[3
]}

Castedo, Jon ^{[4
]}

Serrano, Jose Manuel ^{[5
]}

Besso, Guillermo ^{[6
]}

Tirapu, Juan Pedro ^{[7
]}

Santos, Antonio ^{[8
]}

Mas, Arantxa ^{[9
]}

Parraga, Manuel ^{[10
]}

Jubert, Paola ^{[11
]}

Frutos, Fernando ^{[12
]}

Anon, Jose Manuel ^{[13
]}

Garcia, Manuela ^{[14
]}

Rodriguez, Fernando

Yebenes, Joan Carles ^{[15
]}

Lopez, Maria Jesus ^{[16
]}

机构：

[1] Hosp Sabadell, CIBER Enfermedades Respiratorias, ICU, Sabadell 08208, Spain

[2] Hosp Terrassa, ICU, Terrassa, Spain

[3] Hosp Badalona Germans Trias & Pujol, ICU, Badalona, Spain

[4] Univ Hosp Canarias, ICU, San Cristobal la Laguna, Spain

[5] Hosp Reina Sofia, ICU, Cordoba, Spain

[6] Hosp Carlos Haya, ICU, Malaga, Spain

[7] Hosp Navarra, ICU, Pamplona, Spain

[8] Complexo Univ Hosp, ICU, Santiago De Compostela, Spain

[9] Fdn Althaia, ICU, Manresa, Spain

[10] Hosp Morales Messeguer, ICU, Murcia, Spain

[11] Hosp Santa Tecla, ICU, Tarragona, Spain

[12] Univ Hosp, ICU, Getafe, Spain

[13] Hosp Virgen La Luz, ICU, Cuenca, Spain

[14] Hosp Virgen Macarena, ICU, Seville, Spain

[15] Hosp Mataro, ICU, Mataro, Spain

[16] Hosp Gen Yague, ICU, Burgos, Spain

来源：

INTENSIVE CARE MEDICINE | 2008年 / 34卷 / 08期

关键词：

prone positioning; mechanical ventilation; acute respiratory distress syndrome; randomized controlled trial; survival; acute lung injury;

D O I：

10.1007/s00134-008-1119-3

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objective: We examined the effect on survival of prone positioning as an early and continuous treatment in ARDS patients already treated with protective ventilation. Design and setting: Open randomized controlled trial in 17 medical-surgical ICUs. Patients: Forty mechanically ventilated patients with early and refractory ARDS despite protective ventilation in the supine position. Interventions: Patients were randomized to remain supine or be moved to early (within 48 h) and continuous (>= 20 h/day) prone position until recovery or death. The trial was prematurely stopped due to a low patient recruitment rate. Measurements and results: Clinical characteristics, oxygenation, lung pressures, and hemodynamics were monitored. Need for sedation, complications, length of MV, ICU, and hospital stays, and outcome were recorded. PaO2/FIO2 tended to be higher in prone than in supine patients after 6 h (202 +/- 78 vs. 165 +/- 70 mmHg); this difference reached statistical significance on day 3 (234 +/- 85 vs. 159 +/- 78). Prone-related side effects were minimal and reversible. Sixty-day survival reached the targeted 15% absolute increase in prone patients (62% vs. 47%) but failed to reach significance due to the small sample. Conclusions: Our study adds data that reinforce the suggestion of a beneficial effect of early continuous prone positioning on survival in ARDS patients.

引用

页码：1487 / 1491

页数：5

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