Prone ventilation in severe ARDS
Trial question
Is prone ventilation superior to supine ventilation in patients with severe ARDS?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
37.0% female
63.0% male
N = 136
136 patients (50 female, 86 male).
Inclusion criteria: intubated patients with severe ARDS.
Key exclusion criteria: relapse of > 48 hours since meeting inclusion criteria; SBP < 80 mmHg despite vasopressors; pelvic or spine fractures; cranial trauma, increased ICP; moribund.
Interventions
N=76 prone ventilation (continuous ventilation in face down position for 20 hours/day).
N=60 supine ventilation (ventilation in face up position).
Primary outcome
Death in intensive care unit
43%
58%
58.0 %
43.5 %
29.0 %
14.5 %
0.0 %
Prone
ventilation
Supine
ventilation
No significant
difference ↔
No significant difference in death in the ICU (43% vs. 58%; RR 0.74, 95% CI -0.19 to 1.67).
Secondary outcomes
No significant difference in death in the hospital (50% vs. 62%; RR 0.81, 95% CI -0.48 to 2.1).
No significant difference in length of stay in the ICU (20.5 days vs. 19.1 days; AD 1.4 days, 95% CI -5.41 to 8.21).
No significant difference in pneumothorax (9.2% vs. 6.7%; RR 1.37, 95% CI -6.96 to 9.7).
Safety outcomes
No significant differences in pressure sores, conjunctival hemorrhage.
Conclusion
In intubated patients with severe ARDS, prone ventilation was not superior to supine ventilation with respect to death in the ICU.
Reference
Jordi Mancebo, Rafael Fernández, Lluis Blanch et al. A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006 Jun 1;173(11):1233-9.
Open reference URL