Effect of Prone Positioning on the Survival of Patients with Acute Respiratory Failure

Abstract

Although placing patients with acute respiratory failure in a prone position improves their oxygenation, it does not improve survival.

The FINNALI study on acute respiratory failure: not the final cut

“…These factors have been repeatedly found [12,14]. Of note, this is another study demonstrating that the subset of patients with the worst PaO 2 /FIO 2 values displays the highest mortality [4,15,16]. Perhaps future definitions of ALI/ ARDS will have to consider this special population.…”

An open-access, very-low-field MRI system for posture-dependent 3He human lung imaging

“…For pulmonary physiology in particular, there is a need for non-invasive mapping of the regional distribution of ventilation and perfusion as a function of body orientation and posture [16][17][18][19][20][32][33][34][35]. Additionally, significant questions relating to the care and survival of patients with severe lung diseases such as asthma or acute respiratory distress syndrome relate to postural effects [21,22,36] that an open-access lung MRI could help address. As obesity becomes a national health concern, studying the effect of increased body mass on ventilation, perfusion and lung volume also becomes vital [37], and would be better enabled by an open-access lung MRI.…”

Prone positioning for ARDS: defining the target

“…Experimental data [1] and clinical observations [2][3][4] demonstrate physiologic benefit from prone positioning during acute lung injury (ALI), but recent large clinical trials have been unable to confirm survival benefit in diverse populations of patients labeled as having ALI/acute respiratory distress syndrome (ARDS) [5][6][7]. However, posttrial subgroup analyses hint that certain patient subgroups may indeed benefit from prone orientation.…”

“…However, posttrial subgroup analyses hint that certain patient subgroups may indeed benefit from prone orientation. Severely ill patients, those experiencing improved CO 2 exchange, and those ventilated with large tidal volumes appear more likely to benefit than other members of the general cohort [5]. A superb meta-analysis of pooled data appears in this issue, focusing on those relative few with the worst oxygen exchange [8].…”

“…Clues from the first large Italian trial of PP suggested that, with mortality reduction as the objective, only restricted subsets of patients-those with the most severe disease and those who are recruitable-are good candidates [5,11]. At first glance, the just published prospective follow-up RCT of PP conducted in ARDS patients with moderate to severe hypoxemia both disappoints in not showing overall benefit and affirms that potential benefits are most likely to accrue in those most severely affected [12].…”