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Prone Positioning Compared to Supine During Ventilation

Study finds mortality similar in either positioning, while complications were higher in prone group

TUESDAY, Nov. 10 (HealthDay News) -- Being in a prone position during mechanical ventilation did not improve mortality among patients with acute respiratory distress syndrome (ARDS) and moderate or severe hypoxemia, according to a study in the Nov. 11 issue of the Journal of the American Medical Association.

Paolo Taccone, M.D., of the Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena in Milan, Italy, and colleagues randomized 342 patients with ARDS and moderate or severe hypoxemia on mechanical ventilation to be placed in a prone position or supine position. The primary outcome was all-cause mortality within 28 days, and secondary outcomes were six-month mortality, mortality at discharge from intensive care, organ dysfunction, and complication rates resulting from the prolonged prone positioning.

The researchers did not discern any advantage to either prone or supine positioning; overall, both had similar 28-day mortality (31.0 versus 32.8 percent) and six-month month mortality (47.0 versus 52.3 percent). For patients with moderate hypoxemia, mortality in the prone and supine groups was also similar at 28 days (25.5 versus 22.5 percent) and at six months (42.6 versus 43.9 percent). For patients with severe hypoxemia, the 28-day mortality was 37.8 percent for prone positioning and 46.1 percent for supine positioning, while six-month mortality was 52.7 percent and 63.2 percent respectively. Significantly higher complication rates were observed in the prone positioning group.

"Data from this study indicate that prone positioning does not provide significant survival benefit in patients with ARDS or in subgroups of patients with moderate and severe hypoxemia," the authors write.

One study author reported a former financial relationship with KCI Medical Products, which provided some support for the study.

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