Study of prone positioning to reduce ventilator-associated pneumonia in hypoxaemic patients

• Published in: The European respiratory journal Vol. 35; no. 4; pp. 795 - 804
• Main Authors: Mounier, R, Adrie, C, Francais, A, Garrouste-Orgeas, M, Cheval, C, Allaouchiche, B, Jamali, S, Dinh-Xuan, A. T, Goldgran-Toledano, D, Cohen, Y, Azoulay, E, Timsit, J-F, Ricard, J-D, on behalf of OUTCOMEREA Study Group
• Format: Journal Article
• Language: English
• Published: Leeds Eur Respiratory Soc 01.04.2010; Maney
• Subjects: Acute Disease; Aged; Biological and medical sciences; Case-Control Studies; Databases, Factual - statistics & numerical data; Female; Hospital Mortality; Humans; Hypoxia - mortality; Hypoxia - therapy; Incidence; Intensive Care Units - statistics & numerical data; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Pneumology; Pneumonia - etiology; Pneumonia - mortality; Pneumonia - prevention & control; Predictive Value of Tests; Prone Position; Proportional Hazards Models; Respiration, Artificial - adverse effects; Respiration, Artificial - mortality; Respiratory Insufficiency - mortality; Respiratory Insufficiency - therapy; Respiratory system : syndromes and miscellaneous diseases; Risk Factors; Human; Lung disease; Positioning; Acute lung injury; Ventilator; Pneumonia; Prognosis; prone position; Respiratory disease; Position; Acute; Mortality; ventilator-associated pneumonia; Pneumology
• ISSN: 0903-1936; 1399-3003
• DOI: 10.1183/09031936.00057509

The aim of the present study was to examine whether prone positioning (PP) affects ventilator associated-pneumonia (VAP) and mortality in patients with acute lung injury/adult respiratory distress syndrome. 2,409 prospectively included patients were admitted over 9 yrs (2000-2008) to 12 French intensive care units (ICUs) (OUTCOMEREA). The patients required invasive mechanical ventilation (MV) and had arterial oxygen tension/inspiratory oxygen fraction ratios <300 during the first 48 h. Controls were matched to PP patients on the PP propensity score (+/-10%), MV duration longer than that in PP patients before the first turn prone, and centre. VAP incidence was similar in the PP and control groups (24 versus 13 episodes.1,000 patient-days MV(-1) respectively, p = 0.14). After adjustment, PP did not decrease VAP occurrence (HR 1.64 (95% CI 0.70-3.84); p = 0.25) but significantly delayed hospital mortality (HR 0.56 (95% CI 0.39-0.79); p = 0.001), without decreasing 28-day mortality (37% in both groups). Post hoc analyses indicated that PP did not protect against VAP but, when used for >1 day, might decrease mortality and benefit the sickest patients (Simplified Acute Physiology Score >50). In ICU patients with hypoxaemic acute respiratory failure, PP had no effect on the risk of VAP. PP delayed mortality without decreasing 28-day mortality. PP >1 day might decrease mortality, particularly in the sickest patients.