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Excerpt
Introduction: Recent data suggest that the prone position improves oxygenation in patients with ARDS. The purpose of this study is to describe the response rate, duration of response, and complications of patients with severe ARDS placed in the prone position.
Methods: Ten ICU's (members of the CCCIN) enrolled patients with severe ARDS (bilateral infiltrates, P/F ratio < 150, PAOP < 18 mmHg or no clinical suspicion of left atrial hypertension, PEEP >or=to 8 cm). P/F ratios were obtained in the prone and supine positions. A patient responding to the prone position was defined by a P/F ratio that was >or=to 20% higher in the prone vs supine position. A daily supine assessment was performed and responder patients remained in the prone position. Complications, APACHE II scores, lung injury scores (LIS), and pulmonary parameters were collected.
Results: Twelve (57%) of 21 patients enrolled in the study responded to the prone position (Table 1). The duration of response to the prone position was 24 hrs for 9 patients, 48 hrs for 2 patients, and 192 hrs for 1 patient. Complications related to the prone position occurred in three patients: skin ulceration of the chest, worsening hypoxemia, and concern of decreased hepatic blood flow in a patient with a splenorenal shunt. Responder and non-responder patients had APACHE II and LIS of 25 and 3.0, and 24 and 3.0, respectively. Carbon dioxide exchange, static compliance, and dynamic compliance were not different in the in the prone vs supine position.
Conclusion: The prone position improved oxygenation in 57% of the patients enrolled in this study. The duration of improved oxygenation in responding group of patients was limited. Repositioning and maintaining ARDS patients in the prone position appears to be safe and associated with a low complication rate Further data may be required prior to a prospective randomized controlled trial evaluating the prone position in ARDS patients.
