Background
Methods
Design and ethics
Study population
Main characteristics of protocol use for the prone positioning placement
Data collection
Primary endpoint
Secondary endpoints
Statistical analysis
Results
Study population
Overall | Prone | Supine |
p* | |
---|---|---|---|---|
n
| 98 | 36 | 62 | |
Epidemiological data | ||||
Age (years) (SD) | 64 (18) | 59 (19) | 67 (17) | 0.08 |
Male gender, n (%) | 59 (60) | 22 (61) | 37 (60) | 0.89 |
Weight (kg) (SD) | 83 (24) | 81 (26) | 83 (24) | 0.63 |
BMI (kg/m2) (SD) | 31 (9) | 30 (10) | 31 (10) | 0.77 |
COPD, n (%) | 15 (15) | 6 (17) | 9 (15) | 0.77 |
Ischemic heart disease, n (%) | 15 (15) | 4 (11) | 11 (18) | 0.38 |
Systemic hypertension, n (%) | 60 (61) | 13 (36) | 47 (76) |
0.001
|
Diabetes, n (%) | 29 (30) | 5 (14) | 24 (39) |
0.01
|
Characteristics of ICU severity | ||||
SAPS II (SD) [17] | 53 (17) | 47 (15) | 56 (17) |
0.02
|
Septic shock (at D0), n (%) | 75 (77) | 26 (72) | 49 (79) | 0.44 |
Catecholamine infusion (at D0) | 87 (89) | 33 (92) | 54 (87) | 0.74 |
PaO2/FiO2 and ventilator settings at D0 | ||||
PaO2/FiO2 (mmHg) (SD) | 91 (39) | 74 (24) | 101 (43) |
0.0005
|
Plateau pressure (cm of water) (SD) | 24 (6) | 26 (4) | 23 (7) |
0.02
|
Tidal volume (ml) [IQR] | 446 [400–497] | 444 [400–500] | 448 [400–496] | 0.57 |
PEEP (cm of water) (SD) | 11 (4) | 13 (4) | 10 (3) |
0.0001
|
Adjunctive therapies (during ICU stay) | ||||
Inhaled nitric oxide, n (%) | 24 (24) | 13 (36) | 11 (18) |
0.04
|
NMBA, n (%) | 59 (60) | 32 (89) | 27 (43) |
0.0001
|
Characteristics of abdominal surgery | ||||
Emergent surgery, n (%) | 79 (81) | 30 (83) | 49 (79) | 0.60 |
Peritonitis, n (%) | 41 (42) | 14 (39) | 27 (43) | 0.65 |
Colonic resection, n (%) | 22 (22) | 4 (11) | 18 (29) |
0.04
|
Small bowel resection, n (%) | 27 (28) | 9 (25) | 18 (29) | 0.67 |
Gastric resection, n (%) | 8 (8) | 4 (11) | 4 (6) | 0.46 |
Esophageal resection, n (%) | 7 (7) | 3 (8) | 4 (6) | 0.71 |
Cholecystectomy n (%) | 11 (11) | 5 (14) | 6 (10) | 0.53 |
Partial hepatectomy, n (%) | 3 (3) | 2 (6) | 1 (2) | 0.28 |
Splenectomy, n (%) | 1 (1) | 0 (0) | 1 (2) | 1.00 |
Partial pancreatectomy, n (%) | 3 (3) | 0 (0) | 3 (5) | 0.30 |
Hysterectomy, n (%) | 1 (1) | 0 (0) | 1 (2) | 1.00 |
Parietal resection, n (%) | 8 (8) | 5 (14) | 3 (5) | 0.14 |
Cesarean, n (%) | 3 (3) | 2 (6) | 1 (2) | 0.55 |
HIPEC, n (%) | 1 (1) | 0 (0) | 1 (2) | 1.00 |
≥1 stoma, n (%) | 34 (35) | 10 (28) | 24 (39) | 0.27 |
Colonic stoma, n (%) | 15 (15) | 2 (6) | 13 (21) |
0.04
|
Small bowel stoma, n (%) | 16 (16) | 6 (17) | 10 (16) | 0.95 |
Jejunostomy, n (%) | 5 (5) | 2 (6) | 3 (5) | 1.00 |
Gastrostomy, n (%) | 1 (1) | 0 (0) | 1 (2) | 1.00 |
Open abdomen, n (%) | 4 (4) | 1 (3) | 3 (5) | 1.00 |
Primary endpoint
Prone
n = 36 | Supine
n = 62 |
p
| |
---|---|---|---|
Scar dehiscence, n (%) | 3 (8) | 15 (24) | 0.06 |
Abdominal compartment syndrome, n (%) | 1 (3) | 6 (10) | 0.26 |
Stoma leakage, n (%) | 1 (3) | 13 (2) | 1.00 |
Stoma necrosis, n (%) | 3 (8) | 3 (5) | 0.67 |
Scar necrosis, n (%) | 1 (3) | 1 (2) | 1.00 |
Wound infection, n (%) | 6 (17) | 5 (8) | 0.20 |
Displacement of a peritoneal drainage system | 0 (0) | 1 (2) | 1.00 |
Displacement of a biliary drainage system | 0 (0) | 1 (2) | 1.00 |
Removal of a gastrostomy feeding tube | 0 (0) | 0 (0) | 1.00 |
Removal of a jejunostomy feeding tube | 1 (3) | 0 (0) | 0.37 |
Digestive fistula | 3 (8) | 11 (18) | 0.24 |
Secondary endpoint (Table 3)
Overall | Prone | Supine |
p
| |
---|---|---|---|---|
Primary endpointa, n (%) | 41 (42) | 14 (39) | 27 (44) | 0.65 |
Revision surgeryb, n (%) | 17 (17) | 3 (8) | 14 (23) | 0.10 |
All revision surgeryc
| 35 (36) | 8 (22) | 26 (42) | 0.10 |
Duration of MV | 10 [6–17] | 9.5 [6–21] | 11 [6–15] | 0.72 |
ICU length of stay | 13 [7–22] | 13 [8–24] | 13 [6–21] | 0.77 |
ICU mortalityd, n (%) | 43 (44) | 15 (42) | 28 (45) | 0.43 |