6/29/23, 1:45 AM Prone in hypoxemic ARF Pathway Feedback Search Clinical Topics Home Studies Prone in hypoxemic ARF Prone in hypoxemic ARF Trial question Is prone positioning superior to supine positioning in patients with hypoxemic acute respiratory failure? Study design Multi-center Open label RCT Population Characteristics of study participants 25.0% female N = 791 75.0% male 791 patients (198 female, 593 male) Inclusion criteria: hemodynamically stable, intubated patients with hypoxemic acute respiratory failure Key exclusion criteria: prone positioning for 6 hours/day in the preceding 4 days; contraindications to prone position; high risk of death in < 48 hours; chronic respiratory failure requiring mechanical ventilation Interventions N=413 prone position (face down position for 8 hours/day on standard beds) N=378 supine position (face up position) Primary outcome Death at day 28 32.4 % 32.4 31.5 24.3 % 16.2 % https://web.pathway.md/studies/rec2dTiOcnQqBJQkt 1/2 6/29/23, 1:45 AM Prone in hypoxemic ARF Pathway 8.1 % No significant difference 0.0 % Prone position Supine position No significant difference in death at day 28 (32.4% vs. 31.5%; RR 1.03, 95% CI 0.84 to 1.27) Secondary outcomes No significant difference in death at day 90 (43.3% vs. 42.2%; RR 1.02, 95% CI 0.88 to 1.19) No significant difference in mean duration of mechanical ventilation (13.7 days vs. 14.1 days; MD -0.4, 95% CI -8.58 to 7.78) Significant decrease in ventilator-associated pneumonia (1.66 episodes per 100-patients days vs. 2.14 episodes per 100-patients days; AD -0.48 episodes per 100-patients days, 95% CI -0.95 to -0.01) Safety outcomes No significant difference in adverse events. Significant differences in selective intubation (6 events vs. 0 events), endotracheal tube obstruction (34 events vs. 12 events), pressure sores (208 events vs. 157 events). Conclusion In hemodynamically stable, intubated patients with hypoxemic acute respiratory failure, prone position was not superior to supine position with respect to death at day 28. Reference Claude Guerin, Sandrine Gaillard, Stephane Lemasson et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA. 2004 Nov 17;292(19):2379-87. Open reference URL https://web.pathway.md/studies/rec2dTiOcnQqBJQkt 2/2