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PubMed1980

Value of the prone position in detecting pulmonary nodules by computed tomography.

Computed tomography of the lungs is usually performed in the supine position. The prone position may add important information by countering the effects of gravity on pulmonary vascularity. In addition, better expansion of the posterior lung fields may be achieved in the prone position than possible when the patient lies supine. Three cases are presented in which the prone scan provided significant additional diagnostic information affecting interpretation.

Humans↗
PubMedDate not supplied

[Results of the treatment of cardiac surgery patients with postoperative acute respiratory distress syndrome by prone-position pulmonary ventilation].

Prone position ventilation (PPV) became an effective method of management of ARDS since 1974. Its positive effects on arterial oxygenation have been amply described, but its impact on the results of treatment and hospital mortality remains a disputable point. We observed 2 groups of patients, 36 pts. each, with ARDS after cardiovascular surgery. The main causes of ARDS were shock syndrome, massive blood loss and transfusion, previous COPD, and postcardiopulmonary bypass ALI. Because of impaired lung function (PaO2/FiO2 < 200), all patients were supported by special methods of ventilation including PEEP, high FiO2, and PCV with inverse I:E ratio. In the main group, PPV was started on days 3.6 +/- 1.2 postoperation. Daily duration of PPV was 4-12 h, after which the patients were turned into a supine position. Controls were treated in a supine position. The groups were identical by age, sex, types of surgery, severity of ARF, and manifestations of MOSF. PPV improved lung function and arterial oxygenation. Clinical outcomes were better in the PPV group than in the controls: a lower frequency of threatening arrhythmia, better results of MOSF treatment, and lower mortality (69 and 33.4%, respectively). Prone position is an effective measure improving arterial oxygenation in patients with ARDS after cardiovascular surgery. The main results of PPV are decrease in complications induced by hypoxia and higher survival rate.

Acute Disease↗
PubMed2005

[Reduction of pressure sores during prone positioning of ventilated intensive care patients by the prone-head support system: a pilot study].

OBJECTIVE: Prone positioning in patients with adult respiratory distress syndrome is a well-known method to improve oxygenation. The aim of our study was to evaluate a new device for prone positioning, the prone-head support system (PHS system), with regard to reduction of cutaneous pressure sores. METHODS: In a pilot study we randomized 8 patients with ARDS in two groups: 180 degrees standard prone positioning (group without mask) and prone positioning with the PHS system (group with mask). The PHS system consists of a facemask support, which is connected to an adapted air suspension bed. The patients of both groups were intermittently proned for several days. We evaluated the pressure sores on head and neck before turning the patients prone for the first time and after each period of prone positioning. We documented the quantity, the size, the type and the localization of the pressure sores. RESULTS: There was no significant difference in the mean duration of prone positioning (27.1+/-14.7 hours in the group with mask versus 24.5+/-18.7 h in the group without mask). In the group with mask there were 1.5+/-0.8 new pressure sores by each proning, whereas in the group without mask there were 2.37+/-1.6 new pressure sores, which was lower, but not significantly. The overall area of pressure sores (798 mm2 versus 3184 mm2, p=0.004), the area of pressure sores per patient (199.5+/-104.7 mm2 versus 796+/-478 mm2, p=0.03) and the increase of the area of pressure sores per proning (79.8+/-52.0 mm2 versus 398.0+/-214.3 mm2, p=0.004) were significantly lower in the group with mask in comparison to the group without mask. The lips were the most effected localization in both groups. The pressure sores in the group with mask were less severe and showed a homogenous distribution in comparison to the group without mask. Blisters dominated in the group with mask in comparison to erosions, necrosis and ulcers in the group without mask. CONCLUSION: The PHS system with its face mask is able to reduce the extent and the severity of pressure sores in patients ventilated in prone position. Controlled randomized studies with large study populations seem justified.

Adult↗
PubMed1998

[Perioperative effects of the prone position: anesthesiologic aspects].

The prone position is commonly used for surgery of the spine and the posterior fossa, and is well tolerated by the majority of patients. As long as the abdomen is not compressed, the physiologic impact of this position on cardiorespiratory function is minor, in some cases even less than with the supine position. However extremes of position, particularly of the head and neck, are poorly tolerated and may lead to a variety of severe neurological complications. In addition, several specific forms of pre-existing pathology may predispose the prone patient to major cardiorespiratory complications. In this paper we have systematically reviewed the English and French literature from 1991 to 1997 using Medline Search of peer reviewed journals for the search terms "prone position" and "prone position and venous air embolism". The 330 collected references were reviewed for quality. In combination with review of current standard textbooks these references form the basis for the current report.

Anesthesia↗
PubMed1979

Improved oxygenation and lung compliance with prone positioning of neonates.

Fourteen intubated infants recovering from neonatal respiratory disease had arterial blood gases and lung mechanics measured in the supine position and in two variants of the prone position. Prone positioning resulted in significant increases in mean (+/- SEM) arterial oxygen tension (Pa(o2 70.4 +/- 2.5 to 81.1 +/- 4.4mm Hg), dynamic lung compliance (1.7 +/- 0.24 to 2.55 +/- 0.37 ml/cm H2O),and tidal volume (8.6 +/- 1.0 to 10.5 +/- 1.2 ml) when all prone values were compared to supine values. Prone positioning with the abdomen protruding freely, when compared to all supine values, was associated with significantly increased dynamic lung compliance and tidal volume. Values for prone-abdomen free were not significantly different from values for prone-abdomen restricted. This suggests that there are clinical benefits from prone positioning in neonates recovering from respiratory disease.

Acid-Base Equilibrium↗
PubMed2000

Effects of the supine and prone position on diaphragm thickness in healthy term infants.

BACKGROUND: The physiological basis underlying the decline in the incidence of sudden infant death syndrome (SIDS) associated with changing the sleep position from prone to supine remains unknown. AIMS: To evaluate diaphragm thickness (t(di)) and shortening in healthy term infants in the prone and supine positions in order to determine whether changes in body position would affect diaphragm resting length and the degree of diaphragm shortening during inspiration. METHODS: In 16 healthy term infants, diaphragm thickness at the level of the zone of apposition on the right side was measured using ultrasonography. Heart rate (HR), breathing frequency (f), and transcutaneous oxyhaemoglobin saturation (SaO(2)) were recorded simultaneously during diaphragm imaging with the infants in the supine and prone positions during quiet sleep. RESULTS: At end expiratory (EEV) and at end inspiratory lung volumes (EIV), t(di) increased significantly in the prone position. The change in t(di) during tidal breathing was also greater when the infant was prone. SaO(2), HR, and f were not significantly different at EEV and at EIV in both positions. CONCLUSION: In healthy term infants, placed in the prone position, the diaphragm is significantly thicker and, therefore, shorter, both at EEV and EIV. Diaphragm shortening during tidal breathing is greater when the infant is prone. In the prone position, the decreased diaphragm resting length would impair diaphragm strength, and the additional diaphragm shortening during tidal breathing represents added work performed by the diaphragm. This may compromise an infant's capacity to respond to stressful situations when placed in the prone position and may contribute to the association of SIDS with prone position.

Algorithms↗
PubMed1997

Dramatic effect on oxygenation in patients with severe acute lung insufficiency treated in the prone position.

OBJECTIVE: To confirm the positive effect of prone positioning on oxygenation in patients with acute lung insufficiency. DESIGN: Clinical follow-up study. SETTING: The intensive care unit at a tertiary care academic hospital. PATIENTS: Thirteen patients suffering from severe acute lung insufficiency caused by trauma, septicemia, aspiration, and burn injury. Eleven of the patients had severe hypoxia (oxygenation indices [PaO2/FIO2] < or = 80 torr [< or = 10.7 kPa]). Patients > 70 yrs of age were excluded from the study. INTERVENTIONS: Treatment in the prone position without changing other ventilatory settings than FIO2 when saturation increased. MEASUREMENTS AND MAIN RESULTS: Twelve of the 13 patients responded to treatment in the prone position. The patient that did not respond improved her gas exchange when nitric oxide was instituted. She died, however, from a Gram-negative septicemia. No patient needed extracorporeal membrane oxygenation. Apart from the settings of FIO2 when saturation increased, the ventilatory settings were unchanged. In the prone position, the oxygenation index increased (p < .0002) and the alveolar-arterial oxygen gradient, P(A-a)O2, decreased dramatically (p < .0001). CONCLUSIONS: The prone position significantly improves impaired gas exchange due to severe acute lung insufficiency. It is suggested that this treatment is used before more complex modalities.

Acute Disease↗
PubMed2005

Is the supine position as safe and effective as the prone position for endoscopic retrograde cholangiopancreatography? A prospective randomized study.

BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is usually performed with the patient lying in the prone position, on the assumption that this position is optimal for cannulation of the papilla and for obtaining good-quality radiographic images. The supine position, however, may be more comfortable for the patient and may facilitate airway management, and this study aimed to compare the two positions in terms of procedure outcome, safety, and patient tolerance. PATIENTS AND METHODS: Consecutive patients who were undergoing ERCP were randomized to start the procedure in either the prone position or the supine position. Patients under the age of 18 years, intubated patients, and those who had already undergone endoscopic sphincterotomy were excluded. The difficulty of cannulation was assessed using the Freeman score (1=one to five attempts; 2=six to 15 attempts; 3=more than 15 attempts; 4=failure of cannulation). Total procedure time, patient tolerance, willingness to undergo ERCP in the future, and procedure-related adverse cardiorespiratory events (oxygen desaturation, tachycardia, bradycardia) were also recorded. RESULTS: A total of 34 patients were evaluated (21 men, 13 women; mean age 68, range 20-96), 17 patients in each group. Demographic and clinical features, and the indications for the procedure were similar for the two patient groups. The median Freeman score was significantly lower in the prone group compared with the supine group (1 vs. 3, P=0.0047, rank sum test). Biliary cannulation was achieved in all patients in the prone group, but was not achieved in five patients (29%) in the supine group (P=0.052). In four of these five patients, biliary cannulation was successfully achieved after turning the patient into the prone position. The percentage of patients unwilling to repeat the ERCP procedure in the future was higher in the supine group (29% vs. 6%, P=0.087); the mean tolerance score and mean total procedure time were similar in the two groups. Seven patients in the supine group experienced at least one adverse cardiorespiratory event, compared with only one patient in the prone group (41% vs. 6%, P=0.039). CONCLUSIONS: ERCP performed with the patient in the supine position is technically more demanding for operators used to working with patients in the prone position and carries a greater risk of adverse cardiorespiratory events in nonintubated patients.

Adult↗
PubMed2002

The effects of 10 degrees reverse trendelenburg position on ICP and CPP in prone positioned patients subjected to craniotomy for occipital or cerebellar tumours.

BACKGROUND: Control of ICP-hypertension is of utmost importance during craniotomy. The effects of reverse Trendelenburg position (RTP) upon ICP and CPP have recently been studied in supine positioned patients. METHOD: In this study we investigated changes in intracranial pressure (ICP), mean arterial blood pressure (MABP), CPP and jugular bulb pressure (JBP) before and one minute after 10( degrees ) RTP in 26 prone positioned patients with either occipital (n=12) or cerebellar tumours (n=14). ICP was measured by a subdural approach after removal of the bone flap. Tension of the dura was estimated by the surgeons by digital palpation before and after change in position. FINDINGS: In patients with occipital tumours ICP decreased from 21.0 to 15.6 mm Hg (p<0.05). MABP decreased from 87.9 to 83.3 mm Hg (p<0.05), JBP decreased from 14.3 to 7.7 mm Hg (P<0.05), while CPP was unchanged. In patients with cerebellar tumours ICP decreased from 18.3 to 14.2 mm Hg (p<0.05). MABP decreased from 93,8 to 90.5 mm Hg (p<0.05), JBP decreased from 12.1 to 5.0 mm Hg (P<0.05), while CPP was unchanged. There were no significant differences between the two groups with regard to changes in ICP, MABP, CPP and JBP. The change in ICP was accompanied by a significant decrease in dural tension (p<0.05). INTERPRETATION: In prone positioned patients 10 degrees RTP significantly reduces ICP, JPB and MABP within one minute, while CPP is unchanged.

Adult↗
PubMed2001

High continuous positive airway pressure level induces ventilation/perfusion mismatch in the prone position.

OBJECTIVE: Gas exchange in patients with adult respiratory distress syndrome is influenced by posture. The combined effect of continuous positive airway pressure and posture has not been investigated. We studied the effect of normal spontaneous breathing, and that of continuous positive airway pressure, on ventilation/perfusion distributions in healthy volunteers while they were in supine and prone positions. SETTING: Nuclear medicine department in a university hospital. DESIGN: Experimental study. SUBJECTS: Sixteen healthy volunteers. INTERVENTIONS: In the supine or prone position, the subjects inhaled a technetium-labeled aerosol (technetium-99m diethylenetriamine pentaacetic acid) through a tight-fitting mask. Single photon emission computed tomography images of the lungs were obtained. The subjects then received an intravenous injection of technetium-99m-labeled macroaggregates of albumin, and an identical single photon emission computed tomography imaging was performed. In the group that received continuous positive airway pressure, an end-expiratory pressure of 10 cm H2O was applied during both inhalation and injection. MEASUREMENTS AND MAIN RESULTS: During spontaneous breathing, ventilation/perfusion distribution assessed by regression analysis was uniform (i.e., not significantly different from zero) both in supine and prone positions, with a slope of -1.5 +/- 3.5%/cm supine and 1.5 +/- 3.5%/cm prone. During continuous positive airway pressure breathing in the supine position, ventilation/perfusion had a slope of -3.4 +/- 2.4 compared with 8.3 +/- 1.1%/cm in the prone position according to analysis of spatial resolution. CONCLUSION: There was a less favorable ventilation/perfusion ratio in the prone position when the subjects were exposed to continuous positive airway pressure of 10 cm H2O.

Adult↗
PubMed2002

The early detection of adolescent idiopathic scoliosis in three positions using the scoliometer and real-time ultrasound: should the prone position also be used?

The standing forward bending position is in general use for the early detection of adolescent idiopathic scoliosis. It also reveals humps caused by leg-length inequality and for this reason some workers have advocated using the sitting forward bending position. Most recently the prone position has been evaluated and even recommended. The introduction of B-mode and subsequently real-time ultrasound to measure rib rotation and spinal rotation has involved using the prone position. The numerical description of back humps in scientific studies requires measurements at several levels on the back from T1-S1. This paper utilizes 30 subjects referred by school screening for scoliosis from whom 10-level Scoliometer Angle of Trunk Inclinations (ATIs) were obtained twice in each of three positions--standing forward bending, sitting forward bending and prone. The ATIs were converted to 18 levels and (1) analysed for reproducibility, (2) compared in the three positions, and (3) compared with real-time ultrasound data of rib rotation obtained in the prone position. Several statistical methods are used. The reproducibility is best in the sitting and prone positions. While the prone position produces lower ATI readings, R squared values are significantly higher and Residual Mean Square (RMS) values significantly lower than those for each of the standing and sitting forward bending positions. Though the prone position has clear advantages, it is not advocated in clinical practice for various reasons. More research is needed. The evidence supports the view that the sitting forward bending position has advantages for the early detection of adolescent idiopathic scoliosis.

Adolescent↗
PubMed2003

Prone position and positive end-expiratory pressure in acute respiratory distress syndrome.

OBJECTIVE: To determine whether positive end-expiratory pressure (PEEP) and prone position present a synergistic effect on oxygenation and if the effect of PEEP is related to computed tomography scan lung characteristic. DESIGN: Prospective randomized study. SETTING: French medical intensive care unit. PATIENTS: Twenty-five patients with acute respiratory distress syndrome. INTERVENTIONS: After a computed tomography scan was obtained, measurements were performed in all patients at four different PEEP levels (0, 5, 10, and 15 cm H2O) applied in random order in both supine and prone positions. MEASUREMENTS AND MAIN RESULTS: Analysis of variance showed that PEEP (p <.001) and prone position (p <.001) improved oxygenation, whereas the type of infiltrates did not influence oxygenation. PEEP and prone position presented an additive effect on oxygenation. Patients presenting diffuse infiltrates exhibited an increase of Pao2/Fio2 related to PEEP whatever the position, whereas patients presenting localized infiltrates did not have improved oxygenation status when PEEP was increased in both positions. Prone position (p <.001) and PEEP (p <.001) reduced the true pulmonary shunt. Analysis of variance showed that prone position (p <.001) and PEEP (p <.001) reduced the true pulmonary shunt. The decrease of the shunt related to PEEP was more pronounced in patients presenting diffuse infiltrates. A lower inflection point was identified in 22 patients (88%) in both supine and prone positions. There was no difference in mean lower inflection point value between the supine and the prone positions (8.8 +/- 2.7 cm H2O vs. 8.4 +/- 3.4 cm H2O, respectively). CONCLUSIONS: PEEP and prone positioning present additive effects. The prone position, not PEEP, improves oxygenation in patients with acute respiratory distress syndrome with localized infiltrates.

Adult↗
PubMed2004

The effect of body inclination during prone positioning on intraocular pressure in awake volunteers: a comparison of two operating tables.

Visual loss is a rare, but catastrophic, complication of surgery in the prone position. The prone position increases intraocular pressure (IOP), which may lead to visual loss by decreasing perfusion of the anterior optic nerve. We tested whether the reverse Trendelenburg position ameliorates the increase in IOP caused by prone positioning. Furthermore, we compared two prone positioning set ups. The IOP of 10 healthy awake volunteers was measured in the prone position at 3 different degrees of inclination (horizontal, 10 degrees reverse Trendelenburg, and 10 degrees Trendelenburg) and in the sitting and supine positions in a randomized crossover study comparing the Jackson table and the Wilson frame. In a given eye, all prone IOP values (median [25th-75th percentile] exceeded those of the sitting (15.0 mm Hg [12.8-16.3 mm Hg]) and supine (16.8mm Hg [14.0-18.3 mm Hg]) positions. IOPs in the reverse Trendelenburg, horizontal, and Trendelenburg positions were 20.3 mm Hg (16.3-22.5 mm Hg), 22.5 mm Hg (19.8-25.3 mm Hg), and 23.8 mm Hg (21.5-26.3 mm Hg), respectively (P < 0.001 versus reverse Trendelenburg; dagger P < 0.001 versus horizontal). The reverse Trendelenburg position ameliorated the increase in IOP caused by the prone position. Furthermore, the reverse Trendelenburg position decreased the number of grossly abnormal IOP values (>23 mm Hg) by 50% and 75% compared with the prone horizontal and Trendelenburg positions, respectively. The prone positioning setups did not differ in their effect on IOP. The increase in IOP caused by prone positioning was ameliorated by the reverse Trendelenburg position and was aggravated by the Trendelenburg position. The short time period between changes in position and changes in IOP suggests an important role for ocular venous pressures in determining IOP. Therefore, IOP can be beneficially manipulated by operating table inclination in the prone position.

Adult↗
PubMed2006

Oxygenation and cerebral perfusion pressure improved in the prone position.

BACKGROUND: Treatment of patients in the prone position is a well-established method to improve oxygenation in general intensive care unit (ICU) practice. This method is rarely used in a neurosurgical ICU, considering the risk of intracranial hypertension. The aim of this study was to analyse the effect of prone position on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and systemic oxygenation in patients with reduced intracranial compliance. We hypothesize that the beneficial effects of prone position can outweigh the hazardous effects on the intracranial pressure. METHODS: Eight patients with traumatic brain injury or subarachnoid hemorrhage (SAH) were studied in the supine and prone posture. Hemodynamics, arterial oxygenation, respiratory mechanics, ICP and CPP were continuously measured. RESULTS: A significant improvement in PaO(2) was observed in the prone position, from 12.6 +/- 1.4 kPa to 15.7 +/- 3.2 kPa (P= 0.02). Both intracranial pressure and mean arterial pressure increased in the prone position, from 12 +/- 6 to 15 +/- 4 mmHg (P= 0.03) and from 78 +/- 8 to 88 +/- 8 mmHg (P= 0.005), respectively. Arterial pressure increased to a greater extent than ICP, resulting in improved CPP, from 66 +/- 7 to 73 +/- 8 mmHg (P= 0.03) in the prone position. CONCLUSIONS: The prone position can be used to improve the oxygenation as well as CPP in patients with traumatic brain injury or SAH. However, this method results in raised ICP, and should be used cautiously in patients with reduced intracranial compliance.

Adult↗
PubMed1998

Prone position in mechanically-ventilated patients.

The prone position, initially introduced into respiratory therapy to improve the drainage of secretions, has been suggested to improve oxygenation in anaesthetized and paralysed subjects. Here we report on the results obtained using the prone position in 17 normal subjects, 10 obese subjects and 16 patients with acute respiratory failure (ARF). In normal subjects, the prone position did not alter respiratory system compliance (Crs,st, 80.9 +/- 16.6 versus 75.9 +/- 13.2 mL.cmH2O-1), while it did improve arterial oxygen tension (Pa,O2, 21.3 +/- 4.9 versus 26.5 +/- 2.1 kPa, p < 0.01), this improvement being paralleled by an increase in functional residual capacity (FRC, 1.935 +/- 0.576 versus 2.921 +/- 0.681 L, p < 0.01). In obese subjects, the FRC (0.894 +/- 0.327 versus 1.980 +/- 0.856 L, p < 0.01) and the lung compliance (CL,st, 91.4 +/- 55.2 versus 109.6 +/- 52.4 mL.cmH2O-1, p < 0.01) increased in the prone position, while the chest wall compliance (Ccw,st, 199.5 +/- 58.7 versus 160.5 +/- 45.4 mL.cmH2O-1, p < 0.01) decreased and the Crs,st remained substantially unaffected (55.4 +/- 9.6 versus 59.6 +/- 12.1 mL.cmH2O-1). In these subjects, the improvements in FRC and CL,st were always paralleled by an increase in Pa,O2 (17.3 +/- 4.1 versus 24.1 +/- 3.7 kPa, p < 0.01). In ARF patients, no difference between the supine and prone position was found either in FRC (1.17 +/- 0.41 versus 1.29 +/- 0.57 L), or in Crs,st (38.4 +/- 13.7 versus 35.9 +/- 10.7 mL.cmH2O-1) or CL,st (52.4 +/- 23.3 versus 53.9 +/- 23.6 mL.cmH2O-1) despite a significant reduction in Ccw,st being observed (204.8 +/- 97.4 versus 135.9 +/- 52.5, p < 0.01). In this group of patients, the use of the prone position resulted in a significant increase in Pa,O2 (13.7 +/- 3.2 versus 17.2 +/- 4.4 kPa, p < 0.05), being the oxygenation improvement induced by the prone position relative to the baseline Ccw,st, according to the relationship: Pa,O2 = -32.4 + (0.24 x Ccw,st); r = 0.82, p < 0.01). The mechanisms which can be hypothesized to justify the modifications reported above are discussed.

Acute Disease↗
PubMed2001

Pathophysiology of prone positioning in the healthy lung and in ALI/ARDS.

Prone position was initially introduced in healthy anesthetized and paralyzed subjects for surgical specific reasons. Then, it was used during acute respiratory failure to improve gas exchange. The interest on prone position during ALI/ARDS progressively increased, even if the mechanisms leading to a respiratory improvement are not yet completely understood. In normal subjects, during anesthesia and paralysis, prone position determines a more homogeneous distribution of the gravitational gradient of alveolar inflation, a ventilation distributed towards the non dependent lung regions and a reverse of the gravitational distribution of regional perfusion, even if factors other than gravity are involved. Moreover, prone position causes, both in healthy subject and in obese patients, an improvement in oxygenation and in functional residual capacity without affecting respiratory system, lung and chest wall compliance. In ALI/ARDS patients, prone position lead to a reverse of the alveolar inflation and ventilation distribution, due to the reverse of hydrostatic pressure overlying lung parenchyma, the reverse of heart weight, and the changes in chest wall shape and mechanical properties. Little data are available for the modifications in regional lung perfusion. The possible mechanisms involved in oxygenation improvement during prone position in ALI/ARDS patients are: 1) increased lung volumes; 2) redistribution of lung perfusion; 3) recruitment of dorsal spaces with more homogeneous ventilation and perfusion distribution. From a clinical point of view, prone position seems to be a very promising treatment for ALI/ARDS, even if its use is not yet a standard clinical practice. We have recently finished a randomized-controlled trial in order to investigate the clinical impact of this procedure. In the preliminary phase of the study performed in 35 Italian Intensive Care Units, we studied, from 1996 to 1998, 73 patients with a PaO2/FiO2 of 123 +/- 42 and a SAPS (Simplified Acute Physiology Score) of 38 +/- 11. After the first hour of prone positioning, the PaO2/FiO2 ratio of 76% of the patients had increased by more than 20 mmHg (responder) with a mean increase of 78 +/- 53 mmHg. The proportion of responders increased to 85% after 6 hours of prone positioning. The incidence of maneuver-related complications and severe and life-threatening complications was extremely rare. The overall mortality at ICU discharge was 51% and the ICU stay was similar in survivors and non survivors (17.8 +/- 11.6 vs 17.8 +/- 11.4 days).

Anesthesia↗
PubMed1998

Improved oxygenation using the prone position in patients with ARDS.

BACKGROUND: The prone position is known to increase oxygen uptake in patients with Adult Respiratory Distress Syndrome (ARDS). METHODS: In this clinical study from 1995-96, 14 ARDS patients with severe respiratory failure were treated for at least 1 h in the prone position. Responders, defined as having more than 10% increase in PaO2/FiO2 ratio from baseline after 1 h, were treated at least 6 h in the prone position. RESULTS: 11 patients responded during the first period of the prone position (primary responders). Two of the 3 non-responders were turned prone a second time with increase in the PaO2/FiO2 ratio (secondary responders). Mean PaO2/FiO2 ratio (mean +/- SEM) in the supine position was 11.7 +/- 0.8 kPa, increasing to 16.6 +/- 1.8 kPa and 18.0 +/- 1.4 kPa after 1 and 6 h respectively (P = 0.009). Mean time spent in the prone position was 69 h (range 3-256 h), and mean ventilatory time was 17 d (3-52 d). The mortality in this subgroup of our patients with ARDS was 42%, compared to 58% in 19 patients not turned prone in the same period. CONCLUSION: The prone position together with PEEP appears to improve ventilation-perfusion matching. The prone position is simple, effective and readily available and could be used early in most patients with ARDS.

Adolescent↗