IMPROVED OXYGENATION USING THE PRONE POSITION IN PATIENTS WITH ARDS

Background: The prone position is known to increase oxygen uptake in p atients with Adult Respiratory Distress Syndrome (ARDS). Methods: In t his clinical study from 1995-96, 14 ARDS patients with severe respirat ory failure were treated for at least 1 h in the prone position. Respo nders, defined as having more than 10% increase in PaO2/FiO(2) ratio f rom baseline after 1 h, were treated at least 6 h in the prone positio n. Results: 11 patients responded during the first period of the prone position (primary responders). Two of the 3 non-responders were turne d prone a second time with increase in the PaO2/FiO(2) ratio (secondar y responders). Mean PaO2/FiO(2) ratio (mean+/-SEM) in the supine posit ion was 11.7+/-0.8 kPa, increasing to 16.6+/-1.8 kPa and 18.0+/-1.4 kP a after 1 and 6 h respectively (P=0.009). Mean time spent in the prone position was 69 h (range 3-256 h), and mean ventilatory time was 17 d (3-52 d). The mortality in this subgroup of our patients with ARDS wa s 42%, compared to 58% in 19 patients not turned prone in the same per iod. Conclusion: The prone position together with PEEP appears to impr ove ventilation-perfusion matching. The prone position is simple, effe ctive and readily available and could be used early in most patients w ith ARDS.