Prone Positioning Improves Oxygenation in Post-Traumatic Lung Injury—A Prospective Randomized Trial

Abstract

Intermittent prone positioning was not able to reduce the duration of mechanical ventilation in this limited number of patients. However the oxygenation improved significantly over the first four days of treatment, and the prevalence of ARDS and pneumonia were reduced.

Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis

“…40 For the primary outcome, there was no loss to follow-up in 4 trials. 17,35,37,38 In the remaining 6 trials, less than 5% of patients were lost to follow-up (12/802, 16 6/142, 36 (range 4%-32% of all patients), which involved 0%-41% of patients initially assigned to prone positioning and 0%-21% of those assigned to the supine group.…”

“…All of the RCTs analyzed outcomes by assigned group. Seven studies were ended early because of slow recruitment 15,[34][35][36]38,39 or on the basis of a stopping rule for futility. 37 One trial at high risk of bias did not report mortality.…”

“…15,16,36,39 Previous systematic reviews were similarly unable to show reductions in mortality, 41−43 although some suggested a mortality benefit among sicker patients. 13,42 Limitations of earlier trials, including use of injurious tidal volumes (> 8 mL/kg of predicted body weight), enrolment of patients with mild ARDS, 15,16,35,37−39 and inadequate duration of prone positioning, 15,16,38,39 Research CMAJ, July 8, 2014, 186(10) E387 Note: CI = con dence interval. *Random-effects models were used for all analyses except in the nal sensitivity analysis.…”

“…14,17,34,35,37,38 They all had a low risk of bias except one trial 35 (n = 22), which had a high risk of bias because allocation was not concealed. Mortality was reduced with the use of prone positioning (RR 0.74, 95% CI 0.59-0.95; I 2 = 29%) compared with use of the supine position alone (Figure 2).…”

Respiratory Care Year in Review 2011: Long-Term Oxygen Therapy, Pulmonary Rehabilitation, Airway Management, Acute Lung Injury, Education, and Management

“…A meta-analysis of 7 studies involving prone positioning was reported in 2011 by Abroug et al 81 Three earlier studies included a mix of ALI and ARDS patients, applied the prone position for a shorter duration (7-11 h/d), and did not apply LPV. [82][83][84] The 4 later studies included only patients with ARDS, applied the prone position longer (17-24 h/d), and applied an LPV strategy in all patients. [85][86][87][88] Overall ICU mortality for the entire group was not reduced with prone position, but there was a significant improvement when the later 4 studies were analyzed separately.…”