ARDS: Prone position mech.
Clinical - Respiratory/Pulmonary
According to Miller, “Prone positioning is fraught with difficulty” and can result in accidental extubation, dislodgement of the line or chest tube, and patient injury, “but it can lead to higher functional residual capacity, better drainage of secretions, and improved oxygenation.” Gattinoni and colleagues performed a multicenter, prospective randomized trial in patients with ARDS to compare supine positioning with prone positioning for 6 or more hours per day for 10 days. Three hundred four patients were enrolled. Oxygenation was improved in the prone group, but again, mortality did not differ between the two groups. Although there may be specific patients who can benefit from this technique, “routine use of prone positioning is not supported by the data.”
Interest in prone positioning was rekindled by the Proseva study, which randomized 466 patients with severe ARDS to prone vs. supine positioning and found a statistically-significant (and clinically powerful) reduction in mortality (32.8% and 16.0% in the supine and prone groups, respectively (p<0.001) [Guérin C et al. NEJM 368: 2159, 2013]
- Higher FRC
- Better drainage of secretions
- Improved oxygenation