A prospective survey of early 12-h prone positioning effects in patients with the acute respiratory distress syndrome

Objectives: To evaluate of the oxygenation effects of 12-h prone positioning (PP) in ARDS patients and to assess the safety of such a procedure. Design and setting: Prospective observational study in a medical intensive care unit (12 beds) of a university hospital. Patients: 51 consecutive ARDS patients. Intervention: PP for at least 12 h daily until recovery or death. Measurements and results: Arterial blood gases were collected before and during PP and I h after return to supine. Turning adverse events, cutaneous bedsores, and enteral nutrition intolerance were specifically monitored and collected daily by a referring physician. In total 224 PP sessions were performed. Oxygenation improved I h after the turn and continued improving over the 12-h period (4). The beneficial effect persisted I h after return to supine (01). We considered 96% patients responders: 45% as early responders and 53% persistent responders (persistent benefit after return to supine). Four significant adverse events occurred during the 448 turning maneuvers (0.9%). Stage III ulceration and stage IV necrosis cutaneous bedsores occurred in ten patients (20%). Enteral nutrition intolerance was reported in 25% but without inability to meet patient's caloric requirement. Conclusions: Twelve-hour PP is a safe procedure and allows a continuous oxygenation improvement throughout the entire session.