Prone-Supine
Trial question
Is the prone position superior to the supine position in patients with acute respiratory failure?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
30.0% female
70.0% male
N = 304
304 patients (90 female, 214 male).
Inclusion criteria: patients with acute lung injury or the ARDS.
Key exclusion criteria: age < 16 years; contraindication to prone positioning; cardiogenic pulmonary edema; cerebral edema; intracranial hypertension; fractures of the spine; severe hemodynamic instability.
Interventions
N=152 prone position (face down position for ≥ 6 hours/day for 10 days).
N=152 supine position (face up position).
Primary outcome
Death at 10 days
21.1%
25%
25.0 %
18.8 %
12.5 %
6.3 %
0.0 %
Prone
position
Supine
position
No significant
difference ↔
No significant difference in death at 10 days (21.1% vs. 25%; RR 0.84, 95% CI 0.56 to 1.27).
Secondary outcomes
No significant difference in death at the time of discharge from the ICU (50.7% vs. 48%; RR 1.05, 95% CI 0.84 to 1.32).
No significant difference in death at 6 months (62.5% vs. 58.6%; RR 1.06, 95% CI 0.88 to 1.28).
Significantly greater improvement in the ratio of partial pressure of arterial oxygen to FiO2 (63 vs. 44.6; AD 18.4 , 95% CI 2.88 to 33.92).
Safety outcomes
No significant difference in complications related to positioning.
Conclusion
In patients with acute lung injury or the ARDS, prone position was not superior to supine position with respect to death at 10 days.
Reference
L Gattinoni, G Tognoni, A Pesenti et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med. 2001 Aug 23;345(8):568-73.
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