Prone Positioning for Acute Respiratory Distress Syndrome in the Surgical Intensive Care Unit: Who, When, and How Long?

Surgery. 2000 Oct;128(4):708-16. doi: 10.1067/msy.2000.108225.

Abstract

Background: We evaluated the effects of prone positioning (PP) on surgery and trauma patients with acute respiratory distress syndrome (ARDS).

Methods: Patients with ARDS were studied. Exclusion criteria were contraindications to PP. Patients were evaluated in the supine position and after being turned to the PP. After 6 hours, patients were returned to the supine position for 3 hours. One hour after each position change, arterial and mixed venous blood was drawn and analyzed for blood gases and pH, and hemodynamics were measured.

Results: Over 20 months, 27 patients met the criteria, and 20 of the patients were entered into the study. On day 1, 18 of 20 patients (90%) responded with an increase in PaO(2) during PP. On day 2, 16 of 17 patients (94%) responded; on day 3, 15 of 16 patients responded (94%); on day 4, 11 of 13 patients responded (85%); on day 5, 8 of 8 patients responded (100%); and on day 6, 4 of 5 patients responded (80%). Pao(2)/Fio(2) and Qs/Qt were significantly improved (P<.05) during PP. There were 91 periods of PP, lasting 10.3+/-1.2 hours. Of 91 changes to PP, 78 changes (86%) resulted in an improvement in Pao(2)/Fio(2) of more than 20%.

Conclusions: PP improves oxygenation in ARDS for 6 days with few complications.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Blood Gas Analysis
  • Critical Care / methods*
  • Female
  • Hemodynamics
  • Humans
  • Lung Compliance
  • Male
  • Middle Aged
  • Oxygen / blood
  • Positive-Pressure Respiration
  • Postoperative Care / methods*
  • Prone Position / physiology
  • Prospective Studies
  • Pulmonary Gas Exchange
  • Respiratory Distress Syndrome, Adult / therapy*
  • Treatment Outcome

Substances

  • Oxygen