Study Design Summary: 466 patients with severe ARDS were split roughly 50/50 into prone versus stand care groups. Prone group spent at least 16 consecutive hours per day in the prone position. To be included patients needed to be intubated and mechanically vented for ARDS for less than 36 hours. Primary end point was 28 day all cause mortality.
Notes: Severe ARDS here is P:F <150 mm Hg. The most common cause of ARDS in this study was pneumonia, which is probably consistent with what most ICUs see. More patients in the supine group needed rescue therapies; the groups were very well balanced and equal amongst factors such as pH, PPlat, TV, PEEP, PaO2, PaCO2, FiO2, SOFA score, coexisting conditions and such. Both groups received low-tidal ventilation and therapeutic paralysis. The prone group had more adverse events such as unexpected extubation but this was a smaller difference than the survival benefit conferred.
The prone group had a decreased rate of mortality at both 28 days and 90 days as well as shorter time to successful extubation and greater proportion of patients extubated at 90 days. The prone group had shorter ICU stays and more ventilator free days.
All patients in the study had standard ICU beds with proning protocol, no proning beds.
Study Conclusion: Prone positioning for at least 16 consecutive hours per day reduces 28 day all cause mortality in patients with severe ARDS.
Fusion Beat Bottom Line Impression: Prone positioning provides mortality, LOS and extubation benefit to patients with severe ARDS (P:F <150mmHg).
A Fusion Beat 