5/30/2014 Yielding Positions Prone positioning improves VQ To - PDF document

5/30/2014 Yielding Positions  Prone positioning improves VQ To Prone or Not to mismatch Prone?  Prone positioning improves arterial oxygenation John H. Turnbull, MD Assistant Professor of Anesthesia and Perioperative Medicine  Prone position may be helpful for some patients The Clinical Question Does the current data support the ROUTINE use of extended prone positioning in moderate to severe ARDS? 1

5/30/2014 Enrollment Exclusion Criteria • Contraindication for Prone Positioning 3449 Patients – ICP > 30, massive hemoptysis, sternotomy within 5 days, unstable Identified with spine, femur or hip fractures, MAP < 65 mm Hg ARDS • Use of iNO or ECLS prior to enrollment • Burns > 20% BSA 1434 Screened • Life expectancy < 1 year • NIPPV for > 24hrs prior to inclusion • Chronic respiratory failure 576 Eligible 2

5/30/2014 Baseline Characteristics Baseline Characteristics Characteristic Supine Group Prone Group (N = 229) (N = 237) SOFA score 10.4 + 3.4 9.6 + 3.2 Use of vasopressors 83% 72.6% Use of NM blockade 82.3% 91% Baseline Characteristics https://www.youtube.com/watch?v=E_6jT9R7WJs Characteristic Supine Group Prone Group (N = 229) (N = 237) Body-mass index 29 + 7 28 + 6 3

5/30/2014 Study Center Requirement All participating centers must have had 5 years of experience prior to participation Increased GOC Transitions • Non-blinded – Use of fluids not reported – Causes of death not reported 4

5/30/2014 Kaplan Meier Curves Prone Complications Complication Prone Supine Events During Positional Change Increased 80.4 56.3 27 sedation/NM blockade Vomiting 29.1 12.6 35.1 Loss of venous 16.1 4 36.6 access Extubation 10.7 4.6 40 Airway obstruction 50.6 34 20.4 Hypotension, 72 54.6 22 arrhythmias,  vasopressors 5

5/30/2014 Conclusion To ensure we first do no harm, further studies are required prior to the initiation of wide-spread, routine proning of patients with moderate- to-severe ARDS 6