Morbi-mortality evaluation in prolonged prone positioning during severe ARDS

Introduction: It is known that better outcomes are related with longer periods of prone positioning (1 ) in the management of ADRS, but there is uncertainty about optimal time and complications associated with prolonged prone sessions. In our center we have five years of experience in prone positioning, guiding treatment duration with the improvement in oxygenation parameters. The primary outcome of this study is to evaluate the correlation between prone positioning time, related complications and mortality. Methods: Descriptive, retrospective study of 29 patients admitted in our center with severe ARDS treated with prone positioning between the years 2011 and 2014. The subjects were assigned into two groups: under 72 hours and over 72 hours of prone positioning. Relationship between in-hospital mortality, complications and prone positioning time was analyzed with logistic regression. Results: 15 patients were treated with prone positioning less than 72 hours and 14 for 72 hours or more. 3-fold risk of developing complications was found in patients treated for over 72 hours (RR: 3.1, p=0.037, IC (95%)= 1.07 – 9.02). Pressure ulcers were the most frequent complication. We didn´t find correlation between prone positioning time and in-hospital mortality in our groups. Conclusions: We found a higher relative risk for complications in the group over 72 hours of prone positioning, but with no repercussion in mortality. Because these complications are mild and don9t increase mortality, prolonged prone positioning might be considered as a safe alternative management in patients who show a constant improvement in gas exchange during severe ARDS. 1 Guerin C, et al. N Engl J Med 2013; 368:2159–2168.