Effect of prone positioning on the outcome of patients with posttraumatic respiratory failure

Intermittent prone positioning (PP) is a promising therapy of patients with severe respiratory failure. Evaluations of patient outcomes can not, to da re, be found in the literature. This study was conducted to investigate the effects of intermittent PP on patients with posttraumatic respiratory fail ure (PaO2/FiO2/FiO2 < 280 mmHg) in comparison with conventional therapy in suspine position. The collected data is part of our prospective polytrauma study. 136 polytraumized patients (mean ISS 23.4) were included and evaluat ed. 77 patients had a severe chest trauma with an AIS greater than or equal to 3. Of these, 47 patients developed a respiratory failure. 19 of these p atients were treated conventionally in suspine position, 28 patients were i ntermittingly turned prone. Having similar AIS(3.6 vs. 33), the PP-patients had a significantly severer trauma (ISS 35.8 vs. 24.5). Though the injury severity of the PP-patients was much higher, the time of ventilation (32 vs . 31 d) and the ICU stay (39 vs. 36 d) was similar to the patients treated in suspine position. The mortility of PP-patients was 0 %, of suspine posit ioned patients 26 %. After the first PP the PaO2/FiO2 ratio increased with an average of 82 mmHg (26-151 mmHg). The FiO2 was reduced from 0.45 (0.35-1 .0) to 0.26 (0.21-0.35). Beside the beneficial effect of PP on the oxygenat ion we have, for the first time evidence that PP improves the outcome of pa tients with posttraumatic respiratory failure.