PROSEVA Trial

NEJM

June 6, 2013

Prone Positioning in Severe Acute Respiratory Distress Syndrome.

What was the research question?

  • Does early application of prone positioning improve mortality in patients with moderate to severe ARDS?


How did they do it?

  • A multicenter, randomized, controlled trial in 29 ICUs in France and Spain India.

  • Moderate to severe ARDS and PO2/Fio2 ratio <150 with FiO2 ≥0.6, PEEP ≥5, TV~6ml/kg who were intubated and ventilated for <36 hours and re-confirmed after 12-24 hours of ventilation.

  • 466 patients were randomized to undergo proning positioning for 16 hours daily versus supine positioning where patients remained in a semirecumbent position.


What did they find?

  • All-cause 28-day mortality was lower in the prone positioning group compared to the supine group (16% vs. 32.8%, P<0.001). Hazard ratio for death with prone positioning was 0.39 (95% confidence interval [CI], 0.25 to 0.63).

  • Non-adjusted mortality at day 90, successful extubation at day 90, length of stay in ICU, and ventilator-free days all were significantly better with proning position compared to supine position.

  • No increase in adverse events in prone positioning group.


Any limitations?

  • No data of physiological condition of the excluded patients.

  • There is an imbalance between the groups in baseline SOFA score, vasopressor use, and the use of neuromuscular blockers that could have affected the results.


What does it mean?

  • Proning position for at least 16 hours per day significantly reduced 28-day and 90-day mortality in ARDS patients with PaO2:FiO2 <150.

  • This study impacted critical care practice significantly and prone positioning is now the standard of care.

PROSEVA Trial