IMPROVED OXYGENATION UTILIZING A PRONE POSITIONER IN PATIENTS WITH ACUTE RESPIRATORY-DISTRESS SYNDROME

Objectives: (a) To determine whether placing patients with acute respi ratory distress syndrome in the prone position by a lightweight portab le support frame improves oxygenation, (b) whether one can determine w hich patients benefit from prone positioning, and (c) to determine an effective technique for prone positioning of patients. Design: Prospec tive, controlled trial without blinding. Setting: Medical intensive ca re units in two urban university-affiliated hospitals. Patients: Fifte en patients meeting a standard definition for acute respiratory distre ss syndrome were studied prospectively. Each patient acted as his own control for purposes of comparison. Intervention: Patients were assign ed randomly to begin in either supine or prone positions. The position ing frame was used to turn patients from one position to the other, an d oxygenation, ventilation, respiratory mechanics, and hemodynamics we re measured. Results: Significantly better oxygenation was seen in the prone positions than in the supine (P<0.05). In the overall populatio n there was a decrease in AaDO(2) of 21 mmHg when the patients were pl aced prone. The groups were then divided into responders (n = 9) and n onresponders (n = 6). There were significant differences between the g roups (but not between positions) regarding PaO2, baseline, PaCO2, pul monary artery pressures, and peak inspiratory pressures on the ventila tor and in ICU length of stay and time on mechanical ventilatory suppo rt. Conclusion: Prone positioning improves oxygenation in the majority of patients studied and can be achieved relatively easily.