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Is a short trial of prone positioning sufficient to predict the improvement in oxygenation in patients with acute respiratory distress syndrome?

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Objective: To determine whether a 1-h trial of prone positioning is sufficient to identify responders. Design: Prospective clinical cohort study in a medico-surgical ICU in a teaching hospital. Patients: 49 patients with acute respiratory distress syndrome. Interventions: A 6-h period of prone positioning. Measurements and results: Baseline measurements (blood gas analysis and respiratory parameters) were evaluated in supine position just prior to turning the patients prone. Measurements were then repeated 1 h after the beginning of prone positioning (PP1h) and at the end of the 6-h period of prone positioning (PP6h). The last measurements were performed 1 h after repositioning the patients supine. Prone position induced an increase in the PaO2/FIO2 ratio (p<0.001). A response (increase in PaO2/FIO2 ratio of at least 20% at PP1h and/or at PP6h) was observed in 37 of 49 patients (76%). Twenty-seven of these patients (73%) were responders at PP1h while 10 (27%) were responders only at PP6h. In all, two-thirds of the patients were considered persistent responders. However, whereas the PaO2/FIO2 ratio decreased significantly 1 h after repositioning the fast responders supine, the PaO2/FIO2 ratio remained unchanged after repositioning slow responders. Conclusions: A short-term trial of prone positioning does not appear a sufficient method to identify patients who would benefit from the postural treatment.

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Final revision received: 27 April 2000

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Papazian, L., Paladini, MH., Bregeon, F. et al. Is a short trial of prone positioning sufficient to predict the improvement in oxygenation in patients with acute respiratory distress syndrome?. Intensive Care Med 27, 1044–1049 (2001). https://doi.org/10.1007/s001340000799

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  • DOI: https://doi.org/10.1007/s001340000799

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