Prone positioning in severe acute respiratory distress syndrome.
Open accessAbstract
BACKGROUND: Previous trials involving patients with the acute respiratory distress syndrome (ARDS) have failed to show a beneficial effect of prone positioning during mechanical ventilatory support on outcomes. We evaluated the effect of early application of prone positioning on outcomes in patients with severe ARDS. METHODS: In this multicenter, prospective, randomized, controlled trial, we randomly assigned 466 patients with severe ARDS to undergo prone-positioning sessions of at least 16 hours or to be left in the supine position. Severe ARDS was defined as a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (FiO2) of less than 150 mm Hg, with an FiO2 of at least 0.6, a positive end-expiratory pressure of at least 5 cm of water, and a tidal volume close to 6 ml per kilogram of predicted body weight. The primary outcome was the proportion of patients who died from any cause within 28 days after inclusion. RESULTS: A total of 237 patients were assigned to the prone group, and 229 patients were assigned to the supine group. The 28-day mortality was 16.0% in the prone group and 32.8% in the supine group (P<0.001). The hazard ratio for death with prone positioning was 0.39 (95% confidence interval [CI], 0.25 to 0.63). Unadjusted 90-day mortality was 23.6% in the prone group versus 41.0% in the supine group (P<0.001), with a hazard ratio of 0.44 (95% CI, 0.29 to 0.67). The incidence of complications did not differ significantly between the groups, except for the incidence of cardiac arrests, which was higher in the supine group. CONCLUSIONS: In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality. (Funded by the Programme Hospitalier de Recherche Clinique National 2006 and 2010 of the French Ministry of Health; PROSEVA ClinicalTrials.gov number, NCT00527813.).
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In 2017, a meta-analysis was published that was updated from a previous meta-analysis published in 2010, to which only 1 study, the PROSEVA trial, published in 2013 was added.
“In 2017, a meta-analysis was published [454] that was updated from a previous meta-analysis published in 2010 [455], to which only 1 study, the PROSEVA trial, published in 2013 [456] was added.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [456]
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- Authors
- Guérin, C., Reignier, J., Richard, J.-C., Beuret, P., Gacouin, A., Boulain, T., Mercier, E., Badet, M., Mercat, A., Baudin, O., Clavel, M., Chatellier, D., Jaber, S., Rosselli, S., Mancebo, J., Sirodot, M., Hilbert, G., Bengler, C., Richecoeur, J., Gainnier, M., Bayle, F., Bourdin, G., Leray, V., Girard, R., Baboi, L., & Ayzac, L.
- Affiliations
- Inserm (FR)
- Hôpital Pontchaillou (FR)
- Centre hospitalier universitaire d'Orléans (FR)
- Université de Tours (FR)
- Université Nantes Angers Le Mans (FR)
- Centre Hospitalier d'Angoulême (FR)
- Centre Hospitalier Universitaire de Limoges (FR)
- Université de Poitiers (FR)
- Centre Hospitalier Saint-Joseph Saint-Luc (FR)
- Hospital de Sant Pau (ES)
- Université de Bordeaux (FR)
- Centre Hospitalier Universitaire de Nîmes (FR)
- Hôpital de la Timone (FR)
- Hospices Civils de Lyon (FR)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2013-06-06
- Volume
- 368
- Issue
- 23
- Pages
- 2159-2168
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2106923828
- Semantic Scholar
- 671d1508c25ca14d9ae4ebfbbe9ed4c72e73d73d
- Cited by
- 4,040
- References
- 25
- Citations by year
- 2026: 192 · 2025: 220 · 2024: 272 · 2023: 398 · 2022: 494 · 2021: 570 · 2020: 588 · 2019: 203 · 2018: 223 · 2017: 208 · 2016: 218 · 2015: 188 · 2014: 190 · 2013: 63 · 2012: 8
- FWCI
- 178.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- prone positioning, acute respiratory distress syndrome, mechanical ventilation, 28-day mortality, 90-day mortality, cardiac arrest, supine position
- MeSH terms
- Aged, Female, Humans, Male, Middle Aged, Oxygen, Positive-Pressure Respiration, Prospective Studies, Respiratory Distress Syndrome, Prone Position, Kaplan-Meier Estimate
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