Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial.
Paolo Taccone,Antonio Pesenti,Roberto Latini,Federico Polli,F Vagginelli,Cristina Mietto,Luisa Caspani,Ferdinando Raimondi,Giovanni Bordone,Gaetano Iapichino,Jordi Mancebo,Claude Guérin,Louis Ayzac,Lluis Blanch,Roberto Fumagalli,Gianni Tognoni,Luciano Gattinoni +16 more
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Data from this study indicate that prone positioning does not provide significant survival benefit in patients with ARDS or in subgroups of patients with moderate and severe hypoxemia.Abstract:
Context Post hoc analysis of a previous trial has suggested that prone positioning may improve survival in patients with severe hypoxemia and with acute respiratory distress syndrome (ARDS). Objective To assess possible outcome benefits of prone positioning in patients with moderate and severe hypoxemia who are affected by ARDS. Design, Setting, and Patients The Prone-Supine II Study, a multicenter, unblinded, randomized controlled trial conducted in 23 centers in Italy and 2 in Spain. Patients were 342 adults with ARDS receiving mechanical ventilation, enrolled from February 2004 through June 2008 and prospectively stratified into subgroups with moderate (n = 192) and severe (n = 150) hypoxemia. Interventions Patients were randomized to undergo supine (n = 174) or prone (20 hours per day; n = 168) positioning during ventilation. Main Outcome Measures The primary outcome was 28-day all-cause mortality. Secondary outcomes were 6-month mortality and mortality at intensive care unit discharge, organ dysfunctions, and the complication rate related to prone positioning. Results Prone and supine patients from the entire study population had similar 28-day (31.0% vs 32.8%; relative risk [RR], 0.97; 95% confidence interval [CI], 0.84-1.13; P = .72) and 6-month (47.0% vs 52.3%; RR, 0.90; 95% CI, 0.73-1.11; P = .33) mortality rates, despite significantly higher complication rates in the prone group. Outcomes were also similar for patients with moderate hypoxemia in the prone and supine groups at 28 days (25.5% vs 22.5%; RR, 1.04; 95% CI, 0.89-1.22; P = .62) and at 6 months (42.6% vs 43.9%; RR, 0.98; 95% CI, 0.76-1.25; P = .85). The 28-day mortality of patients with severe hypoxemia was 37.8% in the prone and 46.1% in the supine group (RR, 0.87; 95% CI, 0.66-1.14; P = .31), while their 6-month mortality was 52.7% and 63.2%, respectively (RR, 0.78; 95% CI, 0.53-1.14; P = .19). Conclusion Data from this study indicate that prone positioning does not provide significant survival benefit in patients with ARDS or in subgroups of patients with moderate and severe hypoxemia. Trial Registration clinicaltrials.gov Identifier: NCT00159939read more
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Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.
R. P. Dellinger,Mitchell M. Levy,Andrew Rhodes,Djillali Annane,Herwig Gerlach,Steven M. Opal,Jonathan E. Sevransky,Charles L. Sprung,Ivor S. Douglas,Roman Jaeschke,Tiffany M. Osborn,Mark E. Nunnally,Konrad Reinhart,Ruth M. Kleinpell,Derek C. Angus,Clifford S. Deutschman,Flávia Ribeiro Machado,Gordon D. Rubenfeld,Steven A R Webb,Richard Beale,Jean Louis Vincent,Rui Moreno +21 more
TL;DR: An update to the “Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock,” last published in 2008 is provided.
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Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012
R. Phillip Dellinger,Mitchell M. Levy,Andrew Rhodes,Djillali Annane,Herwig Gerlach,Steven M. Opal,Jonathan E. Sevransky,Charles L. Sprung,Ivor S. Douglas,Roman Jaeschke,Tiffany M. Osborn,Mark E. Nunnally,Sean R. Townsend,Konrad Reinhart,Ruth M. Kleinpell,Derek C. Angus,Clifford S. Deutschman,Flávia Ribeiro Machado,Gordon D. Rubenfeld,Steven A R Webb,Richard Beale,Jean Louis Vincent,Rui Moreno +22 more
TL;DR: A consensus committee of 68 international experts representing 30 international organizations was convened in 2008 to provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock".
Journal ArticleDOI
Prone Positioning in Severe Acute Respiratory Distress Syndrome
Claude Guérin,Jean Reignier,Jean-Christophe Richard,Pascal Beuret,Arnaud Gacouin,Thierry Boulain,Emmanuelle Mercier,Michel Badet,Alain Mercat,Olivier Baudin,Marc Clavel,Delphine Chatellier,Samir Jaber,Sylvène Rosselli,Jordi Mancebo,Michel Sirodot,Gilles Hilbert,Christian Bengler,Jack Richecoeur,Marc Gainnier,Frédérique Bayle,Gael Bourdin,Véronique Leray,Raphaële Girard,Loredana Baboi,Louis Ayzac +25 more
TL;DR: In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality.
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The acute respiratory distress syndrome.
TL;DR: Progress has been made in understanding the mechanisms responsible for the pathogenesis and the resolution of lung injury, including the contribution of environmental and genetic factors, and on developing novel therapeutics that can facilitate and enhance lung repair.
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An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome
Eddy Fan,Lorenzo Del Sorbo,Ewan C. Goligher,Carol L. Hodgson,Laveena Munshi,Allan J. Walkey,Neill K. J. Adhikari,Marcelo B. P. Amato,Richard D. Branson,Roy G. Brower,Niall D. Ferguson,Ognjen Gajic,Luciano Gattinoni,Dean R. Hess,Jordi Mancebo,Maureen O. Meade,Daniel F. McAuley,Antonio Pesenti,V. Marco Ranieri,Gordon D. Rubenfeld,Eileen Rubin,Maureen A. Seckel,Arthur S. Slutsky,Daniel Talmor,B. Taylor Thompson,Hannah Wunsch,Elizabeth Uleryk,Jan Brozek,Laurent Brochard +28 more
TL;DR: Clinicians managing patients with ARDS should personalize decisions for their patients, particularly regarding the conditional recommendations in this guideline, which is strong for mechanical ventilation using lower tidal volumes and lower inspiratory pressures.
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