What is the evidence for the use of prone position ventilation in ARDS?

Intervention
Population
Conclusion

RCT: PROSEVA

Guerin et al
NEJM (2013)

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  • Prone ventilation for 16 hours per day for up to 5 days
  • 474 patients with moderate to severe ARDS (P/F ratio <20kPa)
  • Intubated <36 hours
  • Mortality benefit demonstrated with proning (28-day mortality 16% vs. 32.8%, p<0.001)
  • No difference in ICU LOS or other complications such as pneumothorax or bronchial intubation
The Bottom Line Review

Meta-Analysis

Munshi et al
Annals of ATS (2017)

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  • Prone vs. supine position in mechanical ventilation
  • 8 RCTs including 2,129 patients with ARDS
  • Lower mortality in patients proned for >12 hours (RR 0.74) and for all patients with moderate-severe ARDS (RR 0.74)
  • Prone positioning associated with higher rates of ETT obstruction and pressure sores