Prone positioning in hypoxemic ARF
Trial question
Is prone positioning superior to supine positioning in patients with hypoxemic acute respiratory failure?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
25.0% female
75.0% male
N = 791
791 patients (198 female, 593 male).
Inclusion criteria: hemodynamically stable, intubated patients with hypoxemic acute respiratory failure.
Key exclusion criteria: prone positioning for ≥ 6 hours/day in the preceding 4 days; contraindications to prone position; high risk of death in < 48 hours; chronic respiratory failure requiring mechanical ventilation.
Interventions
N=413 prone position (face down position for ≥ 8 hours/day on standard beds).
N=378 supine position (face up position).
Primary outcome
Death at day 28
32.4%
31.5%
32.4 %
24.3 %
16.2 %
8.1 %
0.0 %
Prone
position
Supine
position
No significant
difference ↔
No significant difference in death at day 28 (32.4% vs. 31.5%; RR 1.03, 95% CI 0.84 to 1.27).
Secondary outcomes
No significant difference in death at day 90 (43.3% vs. 42.2%; RR 1.02, 95% CI 0.88 to 1.19).
No significant difference in mean duration of mechanical ventilation (13.7 days vs. 14.1 days; MD -0.4, 95% CI -8.58 to 7.78).
Significant decrease in ventilator-associated pneumonia (1.66 episodes per 100-patients days vs. 2.14 episodes per 100-patients days; AD -0.48 episodes per 100-patients days, 95% CI -0.95 to -0.01).
Safety outcomes
No significant difference in adverse events.
Significant differences in selective intubation (6 events vs. 0 events), endotracheal tube obstruction (34 events vs. 12 events), pressure sores (208 events vs. 157 events).
Conclusion
In hemodynamically stable, intubated patients with hypoxemic acute respiratory failure, prone position was not superior to supine position with respect to death at day 28.
Reference
Claude Guerin, Sandrine Gaillard, Stephane Lemasson et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA. 2004 Nov 17;292(19):2379-87.
Open reference URL