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Journal Articles European Respiratory Journal Year : 2009

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

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Abstract

Whether prone positioning (PP) affects ventilator associated-pneumonia (VAP) and mortality in patients with acute lung injury/adult respiratory distress syndrome.2409 prospectively included patients admitted over 9 years (2000-2008) to 12 French ICUs (OUTCOMEREA((R))), who required invasive mechanical ventilation (MV) and had Pa,O2/FiO2 ratios <300 during the first 48 hours. Controls were matched to PP patients on the PP propensity score (+/-10%), MV duration >/= that in PP patients before the first turn prone, and centre.VAP incidence was similar in the PP and control groups (24 vs. 13 episodes/1000 patient-days of MV, respectively; p=0.14). After adjustment, PP did not decrease VAP occurrence (hazard ratio, 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 (SAPSII>50).In ICU patients with hypoxemic acute respiratory failure, PP had no effect on the risk of VAP. PP delayed mortality without decreasing 28-day mortality. PP for longer than 1 day might decrease mortality, particularly in the sickest patients.

Dates and versions

inserm-00456947 , version 1 (16-02-2010)

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Roman Mounier, Christophe Adrie, Adrien Français, Maïté Garrouste-Orgeas, Christine Cheval, et al.. Study of prone positioning to reduce ventilator-associated pneumonia in hypoxemic patients.. European Respiratory Journal, 2009, epub ahead of print. ⟨10.1183/09031936.00057509⟩. ⟨inserm-00456947⟩
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