Proseva Prone Positioning in Severe Acute Respiratory Distress Syndrome trial

• related: ARDS acute respiratory distress syndrome
• tags: #literature

---

Population

Inclusion

• patients intubated with PEEP of 5
• early initiation: within 36 hours of intubation
• severe ARDS with P:F < 150 mmHg
• TV ventilation 6 cc/kg

Exclusion

• elevated ICP
• massive hemoptysis
• tracheal, facial surgery
• unstable fractures
• pregnant patients
• anterior chest tube with air leak

Intervention

• stabilization of 12 -24 hours initial period
• proned completely for 16 hours a day
• maintain Pplat ≤ 30 and pH 7.2-7.45, RR < 35
• after supination, proning can be resumed at any time
• proning applied every day until day 28

Stopping criteria

• improvement in P:F > 150, with PEEP < 10 and FIO2 < 0.6, in supine position for at least 4 hours after last prone session

Results

• Much lower mortality at day 28 and day 90 (0.42 and 0.48)
• High extubation success at day 90¹

Links to this note

• ARDS acute respiratory distress syndrome
  • Proseva Prone Positioning in Severe Acute Respiratory Distress Syndrome trial
• use proning for severe hypoxemia in ARDS
  • Proseva Prone Positioning in Severe Acute Respiratory Distress Syndrome trial

Footnotes

1. Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159-2168. doi:10.1056/NEJMoa1214103 ↩