Randomized Controlled Trial

. 2013年6月6日； 368（23）：2159-68。

doi: 10.1056/NEJMoa1214103. Epub 2013 May 20.

Prone positioning in severe acute respiratory distress syndrome

Claude Guérin¹, Jean Reignier, 让·克里斯托弗·理查德（Jean-Christophe Richard）, Pascal Beuret, Arnaud Gacouin, Thierry Boulain, Emmanuelle Mercier, 米歇尔·巴德特（Michel Badet）, Alain Mercat, 奥利维尔·鲍丁（Olivier Baudin）, Marc Clavel, Delphine Chatellier, 萨米尔·贾伯（Samir Jaber）, SylvèneRosselli, Jordi Mancebo, Michel Sirodot, Gilles Hilbert, Christian Bengler, 杰克·里奇科尔（Jack Richecoeur）, Marc Gainnier, 弗雷德里克·贝尔（FrédériqueBayle）, Gael Bourdin, Véronique Leray, Raphaele Girard, Loredana Baboi, 路易·阿扎克（Louis Ayzac）, Proseva研究小组

Collaborators, Affiliations

Collaborators

Proseva研究小组:
C Guérin, J C Richard, F Bayle, G Bourdin, V Leray, F Wallet, B Delannoy, S Debord, A Stoian, P Nesme, V Porot, S Rosselli, l argaud, O Martin, J Reignier, E Greau, N Maquigneau, p beuret, Y Le Tulzo, 一个gacouin, t bolain, I Runge, D Benzkri, A Mathonnet, M Skarzynski, A Bretagnol, D Perrotin, E Mercier, V Simeon-Vieules, 默克特, L Masson, m坏了, m clavel, J Tanty, O Baudin, V Gissot, C Cracco, A Desachy, M A Fally, L Robin, R Robert, D Chatellier, V Goudet, E goyheneix, C Guignon, S Jaber, B Young, F Belafia, J Carr, N Rossel, J Mancebo, M Turella, F Roche-Campo, H M Aguirre-Bermeo, G希尔伯特, S Coz, M Sirodot, levrat, M Gainnier, M Bisbal, J Richecoeur, D Combaux, J Y Lefranc, C Bengler, F Casano, s lloret, J F Timsit, A Bonadonna, K Pavaday, F Zeni, E Diconne, D Perez, B Souweine, A Lautrette, A A Hussain, A Demoule, L Kontar, V Cadiergue, L Ayzac, R Girard, L Baboi, J Escande, G弗兰德罗, D Moreau, M Vanhove, M Sidibe, J M Villier, L Ayzac, R Girard, L Baboi, C Guérin, V Schreiber, J Escande, G弗兰德罗, D Moreau, M Vanhove, M Sidibe, R K Albert, J D Chiche, D Tassaux

Affiliation

¹RéanimationMédicale，Hôpitalde la Croix-Rousse，Hospices de Lyon；里昂大学；和Creatis Inserm 1044，法国里昂。claude.guerin@chu-lyon.fr

PMID:23688302
DOI:10.1056/NEJMoa1214103

Free article

Randomized Controlled Trial

Prone positioning in severe acute respiratory distress syndrome

Claude Guérinet al. N Engl J Med. 2013.

Free article

. 2013年6月6日； 368（23）：2159-68。

doi: 10.1056/NEJMoa1214103. Epub 2013 May 20.

Authors

Collaborators

Proseva研究小组:
C Guérin, J C Richard, F Bayle, G Bourdin, V Leray, F Wallet, B Delannoy, S Debord, A Stoian, P Nesme, V Porot, S Rosselli, l argaud, O Martin, J Reignier, E Greau, N Maquigneau, p beuret, Y Le Tulzo, 一个gacouin, t bolain, I Runge, D Benzkri, A Mathonnet, M Skarzynski, A Bretagnol, D Perrotin, E Mercier, V Simeon-Vieules, 默克特, L Masson, m坏了, m clavel, J Tanty, O Baudin, V Gissot, C Cracco, A Desachy, M A Fally, L Robin, R Robert, D Chatellier, V Goudet, E goyheneix, C Guignon, S Jaber, B Young, F Belafia, J Carr, N Rossel, J Mancebo, M Turella, F Roche-Campo, H M Aguirre-Bermeo, G希尔伯特, S Coz, M Sirodot, levrat, M Gainnier, M Bisbal, J Richecoeur, D Combaux, J Y Lefranc, C Bengler, F Casano, s lloret, J F Timsit, A Bonadonna, K Pavaday, F Zeni, E Diconne, D Perez, B Souweine, A Lautrette, A A Hussain, A Demoule, L Kontar, V Cadiergue, L Ayzac, R Girard, L Baboi, J Escande, G弗兰德罗, D Moreau, M Vanhove, M Sidibe, J M Villier, L Ayzac, R Girard, L Baboi, C Guérin, V Schreiber, J Escande, G弗兰德罗, D Moreau, M Vanhove, M Sidibe, R K Albert, J D Chiche, D Tassaux

Affiliation

¹RéanimationMédicale，Hôpitalde la Croix-Rousse，Hospices de Lyon；里昂大学；和Creatis Inserm 1044，法国里昂。claude.guerin@chu-lyon.fr

PMID:23688302
DOI:10.1056/NEJMoa1214103

Abstract

背景：以前的试验涉及急性患者respiratory distress syndrome (ARDS) have failed to show a beneficial effect of prone positioning during mechanical ventilatory support on outcomes. We evaluated the effect of early application of prone positioning on outcomes in patients with severe ARDS.

Methods:In this multicenter, prospective, randomized, controlled trial, we randomly assigned 466 patients with severe ARDS to undergo prone-positioning sessions of at least 16 hours or to be left in the supine position. Severe ARDS was defined as a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (FiO2) of less than 150 mm Hg, with an FiO2 of at least 0.6, a positive end-expiratory pressure of at least 5 cm of water, and a tidal volume close to 6 ml per kilogram of predicted body weight. The primary outcome was the proportion of patients who died from any cause within 28 days after inclusion.

Results:共有237名患者被分配到俯卧组，并将229名患者分配到仰卧组。俯卧群的28天死亡率为16.0％，仰卧群为32.8％（p <0.001）。俯卧定位的死亡危险比为0.39（95％置信区间[CI]，0.25至0.63）。在俯卧群中未经调整的90天死亡率为23.6％，而仰卧群为41.0％（p <0.001），危险比为0.44（95％CI，0.29至0.67）。两组之间并发症的发生率没有显着差异，除了心脏骤停的发生率，仰卧群较高。

Conclusions:In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality. (Funded by the Programme Hospitalier de Recherche Clinique National 2006 and 2010 of the French Ministry of Health; PROSEVA ClinicalTrials.gov number,NCT00527813。）。

Comment in

Crit Care Med. 2014 Aug;42(8):e598-9
在俯卧的通风中，一个好转弯值得另一回合。
Soo Hoo GW. Soo Hoo GW. N Engl J Med. 2013 Jun 6;368(23):2227-8. doi: 10.1056/NEJMe1304349. Epub 2013 May 20. N Engl J Med. 2013. PMID:23688300 不abstract available.
[Comments on: role of the prone position in severe ARDS].
Rieg AD. Rieg AD. Anaesthesist. 2013 Oct;62(10):845-6. doi: 10.1007/s00101-013-2231-5. Anaesthesist. 2013. PMID:23999764 德语。不abstract available.
在急性呼吸窘迫综合征中俯卧。
Guérin C, Reignier J, Richard JC. GuérinC等。 N Engl J Med. 2013 Sep 5;369(10):980-1. doi: 10.1056/NEJMc1308895. N Engl J Med. 2013. PMID:24004127 不abstract available.
在急性呼吸窘迫综合征中俯卧。
Möller M, Neuzner J, Gradaus R. Möller M, et al. N Engl J Med. 2013 Sep 5;369(10):979. doi: 10.1056/NEJMc1308895. N Engl J Med. 2013. PMID:24004128 不abstract available.
在急性呼吸窘迫综合征中俯卧。
Wiedemann S，Strasser RH，Simonis G. Wiedemann S等。 N Engl J Med. 2013 Sep 5;369(10):979-80. doi: 10.1056/NEJMc1308895. N Engl J Med. 2013. PMID:24004129 不abstract available.
在急性呼吸窘迫综合征中俯卧。
他，刘·D。 He H, et al. N Engl J Med. 2013 Sep 5;369(10):980. doi: 10.1056/NEJMc1308895. N Engl J Med. 2013. PMID:24004130 不abstract available.
在急性呼吸窘迫综合征中俯卧。
Lemyze M，Mallat J，Thevenin D. Lemyze M, et al. N Engl J Med. 2013 Sep 5;369(10):980. doi: 10.1056/NEJMc1308895. N Engl J Med. 2013. PMID:24004131 不abstract available.
Prone positioning for 16 h/d reduced mortality more than supine positioning in early severe ARDS.
Thompson BT. Thompson BT. Ann Intern Med。2013年9月17日； 159（6）：JC2。doi：10.7326/0003-4819-159-6-201309170-02002。 Ann Intern Med。2013. PMID:24042385 不abstract available.
High-dose N-acetylcysteine in chronic obstructive pulmonary disease, prone positioning in acute respiratory distress syndrome, and continuous positive airway pressure and exhaled nitric oxide in obstructive sleep apnea.
Lambert AA, Parker AM, Moon KK. Lambert AA, et al. Am J Respir Crit Care Med. 2014 Jan 15;189(2):223-4. doi: 10.1164/rccm.201308-1555RR. Am J Respir Crit Care Med. 2014. PMID:24428648 Free PMC article. 不abstract available.
Proseva试验：是时候翻转ARDS患者了吗？
Trikha A，辛格PM。 Trikha A等。 Natl Med J印度。2013年9月; 26（5）：284-5。 Natl Med J印度。2013. PMID:25017836 不abstract available.
'To prone or not to prone' in severe ARDS: questions answered, but others remain.
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在插管和机械通风的SARS-COV-2患者中俯卧定位。
Chen Y, Zhang J, Feng H, Wan F, Zhang Y, Tan L. Chen Y等。 J Clin Anesth。2021年8月; 71：110258。doi：10.1016/j.jclinane.2021.110258。EPUB 2021 3月29日。 J Clin Anesth。2021. PMID:33812212 Free PMC article. 不abstract available.

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Prone positioning in severe acute respiratory distress syndrome

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