Effect of prone positioning on the survival of patients with acute respiratory failure

Luciano G. Gattinoni, Gianni Tognoni, Antonio Pesenti, Paolo Taccone, Daniele Mascheroni, Violeta Labarta, Roberto Malacrida, Paola Di Giulio, Roberto Fumagalli, Paolo Pelosi, Luca Brazzi, Roberto Latini

Research output: Contribution to journalArticle

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Abstract

Background: Although placing patients with acute respiratory failure in a prone (face down) position improves their oxygenation 60 to 70 percent of the time, the effect on survival is not known. Methods: In a multicenter, randomized trial, we compared conventional treatment (in the supine position) of patients with acute lung injury or the acute respiratory distress syndrome with a predefined strategy of placing patients in a prone position for six or more hours daily for 10 days. We enrolled 304 patients, 152 in each group. Results: The mortality rate was 23.0 percent during the 10-day study period, 49.3 percent at the time of discharge from the intensive care unit, and 60.5 percent at 6 months. The relative risk of death in the prone group as compared with the supine group was 0.84 at the end of the study period (95 percent confidence interval, 0.56 to 1.27), 1.05 at the time of discharge from the intensive care unit (95 percent confidence interval, 0.84 to 1.32), and 1.06 at six months (95 percent confidence interval, 0.88 to 1.28). During the study period the mean (±SD) increase in the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen, measured each morning while patients were supine, was greater in the prone than the supine group (63.0±66.8 vs. 44.6±68.2, P = 0.02). The incidence of complications related to positioning (such as pressure sores and accidental extubation) was similar in the two groups. Conclusions: Although placing patients with acute respiratory failure in a prone position improves their oxygenation, it does not improve survival.

Original languageEnglish
Pages (from-to)568-573
Number of pages6
JournalNew England Journal of Medicine
Volume345
Issue number8
DOIs
Publication statusPublished - Aug 23 2001

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Respiratory Insufficiency
Survival
Prone Position
Confidence Intervals
Intensive Care Units
Oxygen
Pressure Ulcer
Acute Lung Injury
Partial Pressure
Supine Position
Adult Respiratory Distress Syndrome
Multicenter Studies
Mortality
Incidence

ASJC Scopus subject areas

  • Medicine(all)

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Effect of prone positioning on the survival of patients with acute respiratory failure. / Gattinoni, Luciano G.; Tognoni, Gianni; Pesenti, Antonio; Taccone, Paolo; Mascheroni, Daniele; Labarta, Violeta; Malacrida, Roberto; Di Giulio, Paola; Fumagalli, Roberto; Pelosi, Paolo; Brazzi, Luca; Latini, Roberto.

In: New England Journal of Medicine, Vol. 345, No. 8, 23.08.2001, p. 568-573.

Research output: Contribution to journalArticle

Gattinoni, LG, Tognoni, G, Pesenti, A, Taccone, P, Mascheroni, D, Labarta, V, Malacrida, R, Di Giulio, P, Fumagalli, R, Pelosi, P, Brazzi, L & Latini, R 2001, 'Effect of prone positioning on the survival of patients with acute respiratory failure', New England Journal of Medicine, vol. 345, no. 8, pp. 568-573. https://doi.org/10.1056/NEJMoa010043
Gattinoni, Luciano G. ; Tognoni, Gianni ; Pesenti, Antonio ; Taccone, Paolo ; Mascheroni, Daniele ; Labarta, Violeta ; Malacrida, Roberto ; Di Giulio, Paola ; Fumagalli, Roberto ; Pelosi, Paolo ; Brazzi, Luca ; Latini, Roberto. / Effect of prone positioning on the survival of patients with acute respiratory failure. In: New England Journal of Medicine. 2001 ; Vol. 345, No. 8. pp. 568-573.
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AU - Gattinoni, Luciano G.

AU - Tognoni, Gianni

AU - Pesenti, Antonio

AU - Taccone, Paolo

AU - Mascheroni, Daniele

AU - Labarta, Violeta

AU - Malacrida, Roberto

AU - Di Giulio, Paola

AU - Fumagalli, Roberto

AU - Pelosi, Paolo

AU - Brazzi, Luca

AU - Latini, Roberto

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N2 - Background: Although placing patients with acute respiratory failure in a prone (face down) position improves their oxygenation 60 to 70 percent of the time, the effect on survival is not known. Methods: In a multicenter, randomized trial, we compared conventional treatment (in the supine position) of patients with acute lung injury or the acute respiratory distress syndrome with a predefined strategy of placing patients in a prone position for six or more hours daily for 10 days. We enrolled 304 patients, 152 in each group. Results: The mortality rate was 23.0 percent during the 10-day study period, 49.3 percent at the time of discharge from the intensive care unit, and 60.5 percent at 6 months. The relative risk of death in the prone group as compared with the supine group was 0.84 at the end of the study period (95 percent confidence interval, 0.56 to 1.27), 1.05 at the time of discharge from the intensive care unit (95 percent confidence interval, 0.84 to 1.32), and 1.06 at six months (95 percent confidence interval, 0.88 to 1.28). During the study period the mean (±SD) increase in the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen, measured each morning while patients were supine, was greater in the prone than the supine group (63.0±66.8 vs. 44.6±68.2, P = 0.02). The incidence of complications related to positioning (such as pressure sores and accidental extubation) was similar in the two groups. Conclusions: Although placing patients with acute respiratory failure in a prone position improves their oxygenation, it does not improve survival.

AB - Background: Although placing patients with acute respiratory failure in a prone (face down) position improves their oxygenation 60 to 70 percent of the time, the effect on survival is not known. Methods: In a multicenter, randomized trial, we compared conventional treatment (in the supine position) of patients with acute lung injury or the acute respiratory distress syndrome with a predefined strategy of placing patients in a prone position for six or more hours daily for 10 days. We enrolled 304 patients, 152 in each group. Results: The mortality rate was 23.0 percent during the 10-day study period, 49.3 percent at the time of discharge from the intensive care unit, and 60.5 percent at 6 months. The relative risk of death in the prone group as compared with the supine group was 0.84 at the end of the study period (95 percent confidence interval, 0.56 to 1.27), 1.05 at the time of discharge from the intensive care unit (95 percent confidence interval, 0.84 to 1.32), and 1.06 at six months (95 percent confidence interval, 0.88 to 1.28). During the study period the mean (±SD) increase in the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen, measured each morning while patients were supine, was greater in the prone than the supine group (63.0±66.8 vs. 44.6±68.2, P = 0.02). The incidence of complications related to positioning (such as pressure sores and accidental extubation) was similar in the two groups. Conclusions: Although placing patients with acute respiratory failure in a prone position improves their oxygenation, it does not improve survival.

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