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Vol. 45. Issue 6.
Pages 291-296 (June 2009)
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Vol. 45. Issue 6.
Pages 291-296 (June 2009)
Review article
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Prone Position for the Treatment of Acute Respiratory Distress Syndrome: A Review of Current Literature
Evidencias de la posición en decúbito prono para el tratamiento del síndrome de distrés respiratorio agudo: una puesta al día
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Óscar Martínez, Nicolás Nin, Andrés Esteban
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aesteban@ucigetafe.com

Corresponding author.
Servicio de Cuidados Intensivos, CIBER de Enfermedades Respiratorias CB06/06/0044, Instituto de Salud Carlos III, Hospital Universitario de Getafe, Getafe, Madrid, Spain
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Abstract

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) have high incidence and mortality rates. Most of the recently introduced treatments have failed to improve the prognosis of patients with ALI or ARDS or to reduce mortality. Several studies have shown improved oxygenation in the prone position during mechanical ventilation in patients with ARDS. However, current evidence strongly suggests that placing ARDS patients in prone position does not improve survival or reduce the duration of mechanical ventilation. Therefore, though in clinical practice this position may improve refractory hypoxemia in patients with ARDS, there is no evidence to support its systematic use.

Keywords:
Acute respiratory distress syndrome
Acute lung injury
Mechanical ventilation
Prone position
Resumen

La incidencia y la mortalidad de la lesión pulmonar aguda y del síndrome de distrés respiratorio agudo (SDRA) son altas. La mayoría de los nuevos tratamientos no han mejorado el pronóstico de los pacientes con lesión pulmonar aguda/SDRA, de modo que se ha observado una mortalidad similar en los últimos años. Varios estudios han evidenciado un aumento de la oxigenación con el decúbito prono durante la ventilación mecánica en pacientes con SDRA. Actualmente existe una fuerte evidencia de que el decúbito prono en pacientes con SDRA no mejora la supervivencia ni disminuye los días de ventilación mecánica. Por lo tanto, a pesar de que en la práctica clínica puede utilizarse dicha posición para mejorar la hipoxemia refractaria en pacientes con SDRA, no hay evidencia para recomendarla de forma sistemática en estos pacientes.

Palabras clave:
Síndrome de distrés respiratorio agudo
Lesión pulmonar aguda
Ventilación mecánica
Decúbito prono
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References
[1.]
D.G. Ashbaugh, D.B. Bigelow, T.L. Petty, B.E. Levine.
Acute respiratory distress in adults.
Lancet, 2 (1967), pp. 319-323
[2.]
A.L. Katzenstein, C.M. Bloor, A.A. Leibow.
Diffuse alveolar damage. The role of oxygen, shock and related factors.
Am J Pathol, 85 (1976), pp. 209-228
[3.]
G.R. Bernard, A. Artigas, K.L. Brigham, J. Carlet, K. Falke, L. Hudson, et al.
The American- European Consensus Conference on ARDS. Definitions, mechanism, relevant outcomes, and clinical trial coordination.
Am J Respir Crit Care Med, 149 (1994), pp. 818-824
[4.]
A. Esteban, P. Fernández-Segoviano, F. Frutos-Vivar, J.A. Aramburu, L. Nájera, N.D. Ferguson, et al.
Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings.
Ann Intern Med, 141 (2004), pp. 440-445
[5.]
O.R. Luhr, K. Antonsen, M. Karlsson, S. Aardal, A. Thorsteinsson, C.G. Frostell, et al.
Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group.
Am J Resp Crit Care Med, 159 (1999), pp. 1849-1861
[6.]
G.D. Rubenfeld, E. Caldwell, E. Peabody, J. Weaver, D.P. Martin, M. Neff, et al.
Incidence and outcome of acute lung injury.
N Engl J Med, 353 (2005), pp. 1685-1693
[7.]
C.H. Goss, R.G. Broker, L.D. Hudson, G. Rubenfeld.
Incidence of acute lung injury in the United States.
Crit Care Med, 31 (2003), pp. 1607-1611
[8.]
A. Esteban, A. Anzueto, F. Frutos, I. Alía, L. Bochard, T.E. Stewart, et al.
Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day internacional study.
JAMA, 287 (2002), pp. 345-355
[9.]
E. Estenssoro, A. Dubin, E. Laffaire, H. Canales, G. Sáenz, M. Moseinco, et al.
Incidence, clinical course, and outcomes in 217 patients with acute respiratory syndrome.
Crit Care Med, 30 (2002), pp. 2450-2456
[10.]
M.BP. Amato, C.SV. Barbas, D.M. Medeiros, R.B. Magaldi, G.D.P. Schettino, G. Lorenzi, et al.
Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.
N Engl J Med, 338 (1998), pp. 347-354
[11.]
W.M. Zapol, M.T. Snider, J.D. Hill, R.J. Fallat, R.H. Bartlett, L.H. Edmunds, et al.
Extracorporeal oxygenation in severe acute respiratory failure: a randomized prospective study.
JAMA, 242 (1979), pp. 373-410
[12.]
G.R. Bernard, A.P. Wheeler, J.A. Russell, R. Schein, W.R. Summer, K.P. Steinberg, et al.
The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group.
N Engl J Med, 336 (1997), pp. 912-918
[13.]
S. Lundin, H. Mang, M. Smithies, O. Stenqvist, C. Frostell.
Inhalation of nitric oxide in acute lung injury: results of a European multicentre study. The European Study Group of Inhaled Nitric Oxide.
Intensive Care Med, 25 (1999), pp. 911-919
[14.]
J.E. Gadeck, S.J. DeMichele, M.D. Karlstad, E.R. Pacht, M. Donahue, T.E. Alberston, et al.
Effect of enteral feeding with eicosapentaenoic acid, gamma-linoleid acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ADRS Study Group.
Crit Care Med, 27 (1999), pp. 1409-1420
[15.]
The Acute Respiratory Distress Syndrome Network.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.
N Engl J Med, 342 (2000), pp. 1301-1308
[16.]
The Acute Respiratory Distress Syndrome Network.
Ketoconazol for early treatment of acute lung injury and acute respiratory distress syndrome: a randomized controlled trial.
JAMA, 283 (2000), pp. 1995-2002
[17.]
The Acute Respiratory Distress Syndrome Network.
Randomized, placebocontrolled trial of lisofylline for early treatment of acute lung injury and acute respiratory distress syndrome.
Crit Care Med, 30 (2002), pp. 1-6
[18.]
R.B. Hirschl, M. Croce, D. Gore, H. Wiedemann, K. Davis, J. Zwischenberger, et al.
Prospective, randomized, controlled pilot study of partial liquid ventilation in adult acute respiratory distress syndrome.
Am J Resp Crit Care Med, 165 (2002), pp. 781-787
[19.]
S. Derdak, S. Mehta, T.E. Stewart, T. Smith, M. Rogers, T.G. Buchman, et al.
Multicenter Oscillatory Ventilation For Acute Respiratory Distress Syndrome Trial (MOAT) Study Investigators. High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial.
Am J Resp Crit Care Med, 166 (2002), pp. 801-808
[20.]
R.G. Spragg, J.F. Lewis, W. Wurst, D. Hafner, R.P. Baughman, M.D. Wewers, et al.
Treatment of acute respiratory distress syndrome with recombinant surfactant protein C surfactant.
Am J Resp Crit Care Med, 167 (2003), pp. 1562-1566
[21.]
The Acute Respiratory Distress Syndrome Network.
Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome.
N Engl J Med, 354 (2006), pp. 1671-1684
[22.]
S. Manocha, A.C. Gordon, E. Salehifar, H. Groshaus, K.R. Walley, J.A. Russell.
Inhaled beta-2 agonist salbutamol and acute lung injury: an association with improvement in acute lung injury.
Crit Care, 10 (2006), pp. R12
[23.]
W.W. Douglas, K. Rehder, F.M. Beynen, A.D. Sessler, H.M. Marsh.
Improved oxygenation in patients with acute respiratory failure: the prone position.
Am Rev Respir Dis, 115 (1977), pp. 559-566
[24.]
P. Pelosi, L. Brazzi, L. Gattinoni.
Prone position in acute respiratory distress syndrome.
Eur Respir J, 20 (2002), pp. 1017-1028
[25.]
W.J.E. Lamm, M.M. Graham, R.K. Albert.
Mechanism by which the prone position improves oxygenation in acute lung injury.
Am J Resp Crit Care Med, 150 (1994), pp. 184-193
[26.]
P. Pelosi, D. Tubiolo, D. Mascheroni, P. Vicardi, S. Crotti, F. Valenza, et al.
Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury.
Am J Resp Crit Care Med, 157 (1998), pp. 387-393
[27.]
S.D. Mentzelopoulos, C. Roussos, S.G. Zakynthinos.
Prone position reduces lung stress and strain in severe acute respiratory distress syndrome.
Eur Respir J, 25 (2005), pp. 534-544
[28.]
P. Fridrich, P. Krafft, H. Houchleuthner, W. Mauritz.
The effects of long-term prone positioning in patients with trauma-induced adult respiratory distress syndrome.
Anesth Analg, 83 (1996), pp. 1206-1211
[29.]
L. Blanch, J. Mancebo, M. Pérez, M. Martínez, A. Mas, A.J. Betbese, et al.
Short-term effects of prone position in critically ill patients with acute respiratory distress syndrome.
Intensive Care Med, 23 (1997), pp. 1033-1039
[30.]
G. Chatte, J.M. Sab, J.M. Dubois, M. Sirodot, P. Gaussorques, D. Robert.
Prone position in mechanically ventilated patients with severe acute respiratory failure.
Am J Resp Crit Care Med, 155 (1997), pp. 473-478
[31.]
P. Pelosi, D. Tubiolo, D. Mascheroni, P. Vicardi, S. Crotti, F. Valenza, et al.
Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury.
Am J Resp Crit Care Med, 157 (1998), pp. 387-393
[32.]
L. Papazian, F. Bregeon, F. Gaillat, X. Thirion, M. Gainnier, R. Gregoire, et al.
Respective and combined effects of prone position and inhaled nitric oxide in patients with acute respiratory distress syndrome.
Am J Resp Crit Care Med, 157 (1998), pp. 580-585
[33.]
G. Voggenreiter, F. Neudeck, M. Aufmkolk, J. Fassbinder, H. Hirche, U. Obertacke, et al.
Intermittent prone positioning in the treatment of severe and moderate posttraumaatic lung injury.
Crit Care Med, 27 (1999), pp. 2574-2575
[34.]
C. Guérin, M. Badet, S. Rosselli, L. Heyer, J.-M. Sab, B. Langevin, et al.
Effects of prone position on alveolar recruitment and oxygenation in acute lung injury.
Intensive Care Med, 25 (1999), pp. 1222-1230
[35.]
J.A. Johannigman, K.J. Davis, S.L. Miller, R.S. Campbell, F.A. Luchette, S.B. Frame, et al.
Prone positioning for acute respiratory distress síndrome in the surgical intensive care unit: who, when, and how long?.
Surgery, 128 (2000), pp. 708-716
[36.]
H. Dupont, H. Mentec, C. Cheval, P. Moine, L. Fierobe, J.F. Timsit.
Short-term effect of inhaled nitric oxide and prone positioning on gas exchange in patients with severe acute respiratory distress syndrome.
Crit Care Med, 28 (2000), pp. 304-308
[37.]
J.A. Johannigman, K.J. Davis, S.L. Miller, R.S. Campbell, F.A. Luchette, S.B. Frame, et al.
Prone positioning and inhaled nitric oxide: synergistic therapies for acute respiratory distress syndrome.
J Trauma, 50 (2001), pp. 589-595
[38.]
L. Gattinoni, G. Tognoni, A. Pesenti, P. Taccone, D. Mascheroni, V. Labarta, et al.
Effect of prone positioning on the survival of patients with acute respiratory failure.
N Engl J Med, 345 (2001), pp. 568-573
[39.]
M. Gainnier, P. Michelet, X. Thirion, J.M. Arnal, J.M. Sainty, L. Papazian.
Prone position and positive end-expiratory pressure in acute respiratory distress syndrome.
Crit Care Med, 31 (2003), pp. 2719-2726
[40.]
C. Guérin, S. Gaillard, S. Lemasson, L. Ayzac, R. Girard, P. Beuret, et al.
Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial.
JAMA, 292 (2004), pp. 2379-2387
[41.]
A. Vieillard-Baron, A. Rabiller, K. Chergui, O. Peyrouset, B. Page, A. Beauchet, et al.
Prone position improves mechanics and alveolar ventilation in acute respiratory distress syndrome.
Intensive Care Med, 31 (2005), pp. 220-226
[42.]
J. Mancebo, R. Fernández, L. Blanch, G. Rialp, F. Gordo, M. Ferrer, et al.
A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome.
Am J Resp Crit Care Med, 173 (2006), pp. 1233-1239
[43.]
C.M. Lim, E.K. Kim, J.S. Lee, T.S. Shim, S.D. Lee, Y. Koh, et al.
Comparison of the response to the prone position between pulmonary and extrapulmonary acute respiratory distress syndrome.
Intensive Care Med, 27 (2001), pp. 477-485
[44.]
L. Papazian, M. Gainnier, V. Marin, S. Donati, J.M. Arnal, D. Demory, et al.
Comparison of prone positioning and High-frequency oscillatory ventilation in patients with acute respiratory distress syndrome.
Crit Care Med, 33 (2005), pp. 2162-2171
[45.]
A.C. Arroliga, Z.W. Ghamra, A. Pérez-Trepichio, P. Pérez-Trepichio, J.J. Komara Jr, A. Smith, et al.
Incidence of ARDS in an adult population of Northeast of Ohio.
Chest, 121 (2002), pp. 1972-1976
[46.]
R.D. Stapleton, B.M. Wang, L.D. Hudson, G.D. Rubenfeld, E.S. Caldwell, K.P. Steinberg.
Causes and timing of death in patients with ARDS.
Chest, 128 (2005), pp. 525-532
[47.]
L. Gattinoni, F. Vagginelli, E. Carlesso, P. Taccone, V. Conte, D. Chiumello, et al.
Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress síndrome.
Crit Care Med, 31 (2003), pp. 2727-2733
[48.]
J. Reignier, N. Thenoz-Jost, M. Fiancette, E. Legendre, C. Lebert, F. Bontemps, et al.
Early enteral nutrition in mechanically ventilated patients in the prone position.
[49.]
A. Esteban, A. Anzueto, F. Frutos, I. Alía, L. Brochard, T.E. Stewart, Mechanical Ventilation International Study Group, et al.
Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study.
JAMA, 287 (2002), pp. 345-355
[50.]
A. Esteban, N. Ferguson, M. Meade, F. Frutos-Vivar, C. Apezteguia, L. Brochard, For the VENTILA Group, et al.
Evolution of mechanical ventilation in response to clinical research.
Am J Respir Crit Care Med, 177 (2008), pp. 170-177
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