PROSEVA

PROSEVA

What is the role of prone positioning in patients with severe ARDS?

Study design

Population

• 466 patients (148 female, 318 male)
• Inclusion criteria: patients undergoing mechanical ventilation for severe ARDS
• Key exclusion criteria: contraindication for prone positioning, lung transplantation, underlying disease with a life expectancy of < 1 year, or end-of-life decision before inclusion

Interventions

• N=237 performing prone-positioning sessions (within the first hour after randomization for at least 16 consecutive hours)
• N=229 standard supine positioning (remained in semirecumbent position)

Primary outcome

Secondary outcomes

• Significant decrease in death at 90 days (23.6% VS.
  41%; HR 0.44, 95% CI 0.29 to 0.67)
• Significant decrease in successful extubation at 90 day
  (80.5% vs. 65%; HR 0.45, 95% CI 0.29 to 0.7)

Safety outcomes

No significant differences in overall incidence of complications, with the exception of cardiac arrest, which was more common in the supine group.

Conclusion

In patients undergoing mechanical ventilation for severe ARDS, performing prone-positioning sessions were superior to standard supine positioning with respect to death at 28 days.