| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Prolonged prone positioning sessions of at least 16 hours, applied early |
| Control | Supine positioning |
| Population | 466 patients with severe ARDS and PaO2/FiO2 below 150 mmHg |
| Follow-up | 90 days |
| Primary endpoint | 28-day mortality |
| Result | 28-day mortality 16.0% prone versus 32.8% supine (p<0.001), hazard ratio 0.39 (95% CI 0.25 to 0.63). Unadjusted 90-day mortality 23.6% versus 41.0% (p<0.001), hazard ratio 0.44 (0.29 to 0.67). Complication rates did not differ significantly. |
| Secondary endpoints | 90-day mortality, ventilator-free days, complications |
In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality.
The trial authors, in the published abstract
Earlier proning trials were negative; this one succeeded by selecting severe ARDS, proning early, and proning for long sessions. Those three design choices are the intervention, and departing from them is the usual reason proning underperforms in practice. Free, and more effective than any drug in the ARDS armamentarium.
Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013 Jun 6;368(23):2159-68.