Context: Post hoc analysis of a previous trial has suggested that prone positioning may improve survival in patients with severe hypoxemia and with acute respiratory distress syndrome (ARDS).
Objective: To assess possible outcome benefits of prone positioning in patients with moderate and severe hypoxemia who are affected by ARDS.
Design, Setting, And Patients: The Prone-Supine II Study, a multicenter, unblinded, randomized controlled trial conducted in 23 centers in Italy and 2 in Spain. Patients were 342 adults with ARDS receiving mechanical ventilation, enrolled from February 2004 through June 2008 and prospectively stratified into subgroups with moderate (n = 192) and severe (n = 150) hypoxemia.
Interventions: Patients were randomized to undergo supine (n = 174) or prone (20 hours per day; n = 168) positioning during ventilation.
Main Outcome Measures: The primary outcome was 28-day all-cause mortality. Secondary outcomes were 6-month mortality and mortality at intensive care unit discharge, organ dysfunctions, and the complication rate related to prone positioning.
Results: Prone and supine patients from the entire study population had similar 28-day (31.0% vs 32.8%; relative risk [RR], 0.97; 95% confidence interval [CI], 0.84-1.13; P = .72) and 6-month (47.0% vs 52.3%; RR, 0.90; 95% CI, 0.73-1.11; P = .33) mortality rates, despite significantly higher complication rates in the prone group. Outcomes were also similar for patients with moderate hypoxemia in the prone and supine groups at 28 days (25.5% vs 22.5%; RR, 1.04; 95% CI, 0.89-1.22; P = .62) and at 6 months (42.6% vs 43.9%; RR, 0.98; 95% CI, 0.76-1.25; P = .85). The 28-day mortality of patients with severe hypoxemia was 37.8% in the prone and 46.1% in the supine group (RR, 0.87; 95% CI, 0.66-1.14; P = .31), while their 6-month mortality was 52.7% and 63.2%, respectively (RR, 0.78; 95% CI, 0.53-1.14; P = .19).
Conclusion: Data from this study indicate that prone positioning does not provide significant survival benefit in patients with ARDS or in subgroups of patients with moderate and severe hypoxemia.
Trial Registration: clinicaltrials.gov Identifier: NCT00159939.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1001/jama.2009.1614 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Which is easier for beginners: supine or prone position percutaneous nephrolithotomy? Assessment of the learning curve in novice urologists through a randomized clinical trial.
Minerva Urol Nephrol
December 2024
Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Background: Percutaneous nephrolithotomy (PCNL) could be performed in both prone and supine positions. Each position has its own advantages and disadvantages. "Learning curve" is a graph that represents progress of a skill against the time needed to master the technique.
View Article and Find Full Text PDFLetter to the Editor: Single-Position Prone Lateral Interbody Fusion is Associated with Improved Radiographic and Clinical Outcomes at One Year compared to Single-Position Lateral Interbody Fusion: A Single Institution Experience.
Spine (Phila Pa 1976)
January 2025
Chang Gung University, Taoyuan, Taiwan.
Risk factors for biometry prediction error by Barrett Universal II intraocular lens formula in Chinese patients.
Int J Ophthalmol
January 2025
Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China.
Aim: To investigate the influence of postoperative intraocular lens (IOL) positions on the accuracy of cataract surgery and examine the predictive factors of postoperative biometry prediction errors using the Barrett Universal II (BUII) IOL formula for calculation.
Methods: The prospective study included patients who had undergone cataract surgery performed by a single surgeon from June 2020 to April 2022. The collected data included the best-corrected visual acuity (BCVA), corneal curvature, preoperative and postoperative central anterior chamber depths (ACD), axial length (AXL), IOL power, and refractive error.
Background: This study aims to automate the measurement process of posterior condylar offset ratio (PCOR) and anterior condylar offset ratio (ACOR) to improve the Total Knee Arthroplasty (TKA) evaluation. Accurate calculation of PCOR and ACOR, performed manually by orthopedic surgeons, is crucial for assessing postoperative range of motion and implant positioning. Manual measurements, however, are time-consuming, prone to human error, and subject to variability.
View Article and Find Full Text PDFClinical Implication of Prone Position Electrocardiograms in Patients With COVID-19.
Clin Cardiol
January 2025
Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!