use proning for severe hypoxemia in ARDS

• related: ARDS acute respiratory distress syndrome
• tags: #permanent #icu

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The PROSEVA, ACURASYS, and ROSE trials define severe ARDS as a PaO2:FiO2 ratio <150 mm Hg, which is different from the Berlin definitions. The PROSEVA trial was the first to demonstrate a significant mortality benefit in ARDS since the original low tidal volume ventilation trial for ARDS was published in 2000. Early institution of prolonged prone positioning in patients with ARDS with an FiO2 of at least 0.6, a PEEP of at least 5 cm H2O, and a PaO2:FiO2 ratio of <150 mm Hg was associated with a significant decrease in 28-day mortality (16% vs 33%; hazard ratio, 0.42; 95% CI, 0.26-0.66; P <) and 90-day mortality (41% vs 23%; hazard ratio, 0.48. 95% CI, 0.32-0.72; P <). This landmark trial informs current management strategies for moderate to severe ARDS. In this patient who had a PaO2:FiO2 ratio of 184 mm Hg with 0.5 FiO2, prone positioning would not be indicated (choice D is incorrect).¹²³

• prone ventilation improves RV hemodynamics

Links to this note

• ARDS acute respiratory distress syndrome

  • use proning for severe hypoxemia in ARDS

• prone ventilation improves RV hemodynamics

  • related: use proning for severe hypoxemia in ARDS

Footnotes

1. SEEK Questionnaires ↩

2. Guérin C, Reignier J, Richard JC, et al; PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159-2168. PubMed ↩

3. Proseva Prone Positioning in Severe Acute Respiratory Distress Syndrome trial ↩