Cited by 4,040Respiratory Support and MechanismsNeonatal Respiratory Health ResearchNosocomial Infections in ICU

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Prone positioning in severe acute respiratory distress syndrome.

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Guérin, Claude, Reignier, Jean, Richard, Jean-Christophe, Beuret, Pascal, Gacouin, Arnaud, Boulain, Thierry, Mercier, Emmanuelle, Badet, Michel, Mercat, Alain, Baudin, Olivier, Clavel, Marc, Chatellier, Delphine, Jaber, Samir, Rosselli, Sylvène, Mancebo, Jordi, Sirodot, Michel, Hilbert, Gilles, Bengler, Christian, Richecoeur, Jack, Gainnier, Marc, Bayle, Frédérique, Bourdin, Gael, Leray, Véronique, Girard, Raphaele, Baboi, Loredana, Ayzac, Louis·2013·New England Journal of Medicine

DOI 10.1056/nejmoa1214103

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Abstract

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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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: Guérin, Claude
Reignier, Jean
Richard, Jean-Christophe
Beuret, Pascal
Gacouin, Arnaud
Boulain, Thierry
Mercat, Alain
Clavel, Marc
Jaber, Samir
Mancebo, Jordi
Hilbert, Gilles
Gainnier, Marc
Ayzac, Louis
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
DOI: 10.1056/nejmoa1214103
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
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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