Background Although placing patients with acute respiratoryfailure in a prone (face down) position improves their oxygenation60 to 70 percent of the time, the effect on survival is notknown.
Methods In a multicenter, randomized trial, we compared conventionaltreatment (in the supine position) of patients with acute lunginjury or the acute respiratory distress syndrome with a predefinedstrategy of placing patients in a prone position for six ormore hours daily for 10 days. We enrolled 304 patients, 152in each group.
Results The mortality rate was 23.0 percent during the 10-daystudy period, 49.3 percent at the time of discharge from theintensive care unit, and 60.5 percent at 6 months. The relativerisk of death in the prone group as compared with the supinegroup was 0.84 at the end of the study period (95 percent confidenceinterval, 0.56 to 1.27), 1.05 at the time of discharge fromthe intensive care unit (95 percent confidence interval, 0.84to 1.32), and 1.06 at six months (95 percent confidence interval,0.88 to 1.28). During the study period the mean (±SD)increase in the ratio of the partial pressure of arterial oxygento the fraction of inspired oxygen, measured each morning whilepatients were supine, was greater in the prone than the supinegroup (63.0±66.8 vs. 44.6±68.2, P=0.02). The incidenceof complications related to positioning (such as pressure soresand accidental extubation) was similar in the two groups.
Conclusions Although placing patients with acute respiratoryfailure in a prone position improves their oxygenation, it doesnot improve survival.
Source Information
From the Istituto di Anestesia e Rianimazione, Università di Milano, Ospedale Maggiore di Milano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy (L.G., P.T., D.M., P.P., L.B.); the Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (G.T., V.L., P.D., R.L.); the Istituto di Anestesia e Rianimazione, Università di Milano–Bicocca, Ospedale S. Gerardo, Monza, Italy (A.P., R.F.); and the Department of Intensive Care and Anesthesia, Lugano Civic Hospital, Lugano, Switzerland (R.M.).
Address reprint requests to Dr. Gattinoni at the Istituto di Anestesia e Rianimazione, Ospedale Maggiore Policlinico–IRCCS, Via Francesco Sforza 35, I-20122 Milan, Italy, or at gattinon{at}polic.cilea.it.
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