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Published ahead of print on March 23, 2006, doi:10.1164/rccm.200503-353OC

Am. J. Respir. Crit. Care Med., Volume 173, Number 11, June 2006, 1233-1239

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Submitted on March 7, 2005
Accepted on March 23, 2006

A Multicenter Trial of Prolonged Prone Ventilation in Severe Acute Respiratory Distress Syndrome

Jordi Mancebo1*, Rafael Fernandez2, Lluis Blanch2, Gemma Rialp3, Federico Gordo4, Miquel Ferrer5, Fernando Rodriguez6, Pau Garro7, Pilar Ricart8, Immaculada Vallverdu9, Ignasi Gich1, Jose Castano10, Pilar Saura11, Guillermo Dominguez12, Alfons Bonet13, and Richard K Albert14

1 Department of Epidemiology, Hospital de Sant Pau, Barcelona, Spain, 2 Intensive Care Medicine, Hospital de Sabadell and Institut Universitari Fundacio Parc Tauli, Sabadell, Spain, 3 Intensive Care Medicine, Hospital General de Mallorca, Palma de Mallorca, Spain, 4 Intensive Care Medicine, Fundacion Hospital de Alcorcon, Alcorcon, Spain, 5 IDIBAPS, Hospital Clinic, Barcelona, Spain, 6 Intensive Care Medicine, Clinica San Miguel, Pamplona, Spain, 7 Intensive Care Medicine, Hospital de Granollers, Granollers, Spain, 8 Intensive Care Medicine, Hospital Germans Trias i Pujol, Badalona, Spain, 9 Intensive Care Medicine, Hospital de Sant Joan, Reus, Spain, 10 Intensive Care Medicine, Hospital Virgen de las Nieves, Granada, Spain, 11 Intensive Care Medicine, Centre Hospitalari de Manresa, Manresa, Spain, 12 Intensive Care Medicine, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico DF, Mexico, 13 Intensive Care Medicine, Hospital Josep Trueta, Girona, Spain, 14 Department of Medicine, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado, USA

* To whom correspondence should be addressed. E-mail: jmancebo{at}santpau.es.

Rationale: Ventilation in the prone position for about 7 hours per day in patients with the acute respiratory distress syndrome, acute lung injury or acute respiratory failure does not decrease mortality. Whether it is beneficial to administer prone ventilation early, and for longer periods of time, is unknown. Methods: We enrolled 136 patients within 48 hours of tracheal intubation for severe acute respiratory distress syndrome, 60 randomized to supine and 76 to prone ventilation. Guidelines were established for ventilator settings and weaning. The prone group was targeted to receive continuous prone ventilation treatment for 20 hours/day. Results: The intensive care unit mortality was 58% (35/60) in the patients ventilated supine and 43% (33/76) in the patients ventilated prone, P=0.12. The latter had a higher simplified acute physiology score II at inclusion. Multivariate analysis showed that simplified acute physiology score II at inclusion (odds ratio 1.07, P<0.001), number of days elapsed between ARDS diagnosis and inclusion (odds ratio 2.83, P<0.001), and randomization to supine position (odds ratio 2.53, P=0.03) were independent risk factors for mortality. A total of 718 turning procedures were done and prone position was applied for a mean of 17 hours/day for a mean of 10 days. A total of 28 complications were reported, and most were rapidly reversible. Conclusion: Prone ventilation is feasible and safe, and may reduce mortality in patients with severe acute respiratory distress syndrome when it is initiated early and applied for most of the day.
Key words: Respiratory distress syndrome, adult. Respiration, artificial. Prone position.




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