Prone Positioning Decreases Mortality in Severe ARDS

Prone positioning has been in existence since 1974; however, the equipment and technique has now been refined and has proven to decrease mortality in severe ARDS.  Prone positioning decreases the amount of alveolar collapse and decreases V/Q mismatching in patients with severe ARDS.

The first large study to show significant mortality benefit was a study of nearly 450 patients with severe ARDS which demonstrated over 50% decreased 30-day and 90-day mortality compared with standard lung-protective ventilation.[1]

A second meta-analysis confirmed that prone ventilation was superior to conventional lung-protective ventilation in severe ARDS. [2] The meta-analysis showed the following:

1. Reduced mortality (RR 0.74)
2. NNT to save one life was 11
3. Mortality was only decreased if the duration of prone positioning was at least 16 hours/day

Intubated patient with severe ARDS

References:

1. 1. NEJM. 2013; 368: 2159-2168.
2. 2. CMAJ. 2014; 186 (10): E381-E390.