1. A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study
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Guérin, C., Beuret, P., Constantin, J. M., Bellani, G., Garcia-Olivares, P., Roca, O., Meertens, J. H., Maia, P. Azevedo, Becher, T., Peterson, J., Larsson, A., Gurjar, M., Hajjej, Z., Kovari, F., Assiri, A. H., Mainas, E., Hasan, M. S., Morocho-Tutillo, D. R., Baboi, L., Chrétien, J. M., François, G., Ayzac, L., Chen, L., Brochard, L., Mercat, A., Hajjej, Zied, Sellami, Walid, Ferjani, M., Gurjar, Mohan, Assiri, Amer, Al Bshabshe, Ali, Almekhlafi, Ghaleb, Mandourah, Yasser, Hasan, Mohd Shahnaz, Rai, Vineya, Marzida, M., Corcoles Gonzalez, Virgilio, Sanchez Iniesta, Rafael, Garcia, Pablo, Garcia-Montesinos de la Peña, Manuel, Garcia Herrera, Adriana, Roca, Oriol, Garcia-de-Acilu, Marina, Masclans Enviz, Joan Ramon, Mancebo, Jordi, Heili, Sarah, Artigas Raventos, Antonio, Blanch Torra, LluÃs, Roche-Campo, Ferran, Rialp, Gemma, Forteza, Catalina, Berrazueta, Ana, Martinez, Esther, Penuelas, Oscar, Jara-Rubio, Ruben, Mallat, Jihad, Thevenin, D., Zogheib, Elie, Mercat, Alain, Levrat, Albrice, Porot, Veronique, Bedock, B., Grech, Ludovic, Plantefeve, Gaetan, Badie, Julio, Besch, Guillaume, Pili-Floury, Sébastien, Guisset, Olivier, Robine, Adrien, Prat, Gwenael, Doise, Jean-Marc, Badet, Michel, Thouret, J. M., Just, Bernard, Perbet, Sébastien, Lautrette, Alexandre, Souweine, B., Chabanne, Russell, Danguy des Déserts, Marc, Rigaud, Jean-Philippe, Marchalot, Antoine, Rigaud, J. P., Bele, Nicolas, Beague, Sébastien, Hours, Sandrine, Marque, Sophie, Durand, Michel, Payen, J. F., Stoclin, Annabelle, Gaffinel, Alain, Winer, Arnaud, Chudeau, Nicolas, Tirot, Patrice, Thyrault, Martial, Paulet, Rémi, Thyrault, M., Aubrun, Frederic, Guerin, Claude, Floccard, Bernard, Rimmele, T., Argaud, Laurent, Hernu, Romain, Crozon Clauzel, Jullien, Wey, Pierre-François, Bourdin, Gael, Pommier, C., Cueuille, NadÃge, de Varax, null, Marchi, Elisa, Papazian, L., Jochmans, Sebastien, Monchi, M., Jaber, Samir, de Jong, Audrey, Moulaire, Valerie, Capron, Matthieu, Jarrige, L., Barberet, Guillaume, Lakhal, Karim, Rozec, B., Dellamonica, Jean, Robert, Alexandre, Bernardin, G., Danin, Pierre-Eric, Raucoules, M., Runge, Isabelle, Foucrier, Arnaud, Hamada, Sophie, Tesniere, Antoine, Fromentin, Mélanie, Samama, C. M., Mira, Jean-Paul, Diehl, Jean-Luc, Mekontso Dessap, Armand, Arbelot, Charlotte, Demoule, Alexandre, Roche, Anne, Similowski, T., Ricard, Jean-Damien, Gaudry, Stéphane, Dreyfuss, D., de Montmolin, Etienne, da Silva, Daniel, Verdiere, B., Ardisson, Fanny, Lemiale, Virginie, Azoulay, Elie, Bruel, Cédric, Tiercelet, Kelly, Fartoukh, Muriel, Voiriot, Guillaume, Hoffmann, Clement, Leclerc, T., Thille, Arnaud, Robert, Réné, Beuret, Pascal, Beduneau, Gaëtan, Beuzelin, Marion, Tamion, F., Morel, Jérôme, Tremblay, Aymeric, Molliex, S., Amal, Jean-Michel, Meaudre, Eric, Goutorbe, Philippe, Laffon, Marc, Gros, Antoine, Nica, Alexandru, Barjon, Genevieve, Dahyot-Fizelier, Claire, Imzi, Nadia, Gally, Josette, Real, null, Sauneuf, Bertrand, Souloy, Xavier, Girbes, Armand, Tuinman, Pieter Roel, Schultz, Marcus, Winters, Tineke, Mijzen, Lisa, Roekaerts, P. M. H. J., Vermeijden, Wytze, Beishuizen, Albertus, Trof, R., Corsten, Stijn, Kesecioglu, Jozef, Meertens, John, Dieperink, Wim, Pickers, Peter, Roovers, Noortje, Maia, Paulo, Duque, Melanie, Rua, Fernando, Pereira de Figueired, António Manuel, Ramos, Armindo, Fragoso, Elsa, Azevedo, Pilar, Gouveia, Joao, Costa E. Silva, Zélia, Silva, Goncalo, Chaves, Susana, Nobrega, J. J., Lopes, LuÃs, Valerio, Bernardino, Araujo, Ana Carolina, de Freitas, Paulo Telles, Bouw, Maria Jose, Melao, Maria, Granja, C., Marcal, Paulo, Fernandes, Antero, Joao, Gonçalves Pereira, Maia, DionÃsio Faria, Spadaro, Savino, Volta, Carlo Alberto, Bellani, Giacomo, Citerio, G., Mauri, Tommaso, Alban, Laura, Pesenti, A., Mistraletti, Giovanni, Formenti, Paolo, Tommasino, C., Tardini, Francesca, Fumagalli, R., Colombo, Riccardo, Fossali, Tommaso, Catena, E., Todeschini, Manuel, Gnesin, Paolo, Cracchiolo, Andrea Neville, Palma, Daniela, Tetamo, R., Albiero, Daniela, Costantini, Elena, Raimondi, F., Coppadoro, Andrea, Vascotto, Ettore, Lusenti, F., Becher, Tobias, Schädler, Dirk, Weiler, N., Karagiannidis, Christian, Petersson, Johan, Konrad, D., Kawati, Rafael, Wessbergh, Joanna, Valtysson, J., Rockstroh, Matthias, Borgstrom, Sten, Larsson, Niklas, Thunberg, J., Camsooksai, Julie, Briggs, null, Kovari, Ferenc, Cuesta, J., Anwar, Sibs, O’Brien, B., Barberis, Luigi, Sturman, J., Mainas, Efstratios, Karatzas, S., Piza, Petr, Sottiaux, Thierry, Adam, J. F., Gawda, Ryszard, Gawor, Maen, Alqdah, M., Cohen, D., Brochard, Laurent, Baker, A., Ñamendys-Silva, Silvio Antonio, Garcia-Guillen, Francisco Javier, Morocho Tutillo, Diego Rolando, Jibaja Vega, Manuel, Zakalik, Graciela, Pagella, Gonzalo, Marengo, J., KARLI, Mélanie, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Université de Lyon, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Génétique, Reproduction et Développement (GReD ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Hospital General Universitario 'Gregorio Marañón' [Madrid], Vall d'Hebron University Hospital [Barcelona], CIBER de Epidemiología y Salud Pública (CIBERESP), University Medical Center Groningen [Groningen] (UMCG), Centro Hospitalar do Porto, Karolinska University Hospital [Stockholm], Karolinska Institutet [Stockholm], Uppsala University, University of Malaya [Kuala Lumpur, Malaisie], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Keenan Research Centre of the Li Ka Shing Knowledge Institute [Toronto], Université d'Angers - Faculté de médecine (UA UFR Médecine), Université d'Angers (UA)-Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Other departments, Intensive Care Medicine, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, Critical Care, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), University of Malaya = Universiti Malaya [Kuala Lumpur, Malaisie] (UM), Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10, PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Université d'Angers (UA), Guã©rin, C, Beuret, P, Constantin, J, Bellani, G, Garcia-Olivares, P, Roca, O, Meertens, J, Maia, P, Becher, T, Peterson, J, Larsson, A, Gurjar, M, Hajjej, Z, Kovari, F, Assiri, A, Mainas, E, Hasan, M, Morocho-Tutillo, D, Baboi, L, Chrã©tien, J, Franã§ois, G, Ayzac, L, Chen, L, Brochard, L, Mercat, A, Sellami, W, Ferjani, M, Al Bshabshe, A, Almekhlafi, G, Mandourah, Y, Rai, V, Marzida, M, Corcoles Gonzalez, V, Sanchez Iniesta, R, Garcia, P, Garcia-Montesinos de la Peña, M, Garcia Herrera, A, Garcia-de-Acilu, M, Masclans Enviz, J, Mancebo, J, Heili, S, Artigas Raventos, A, Blanch Torra, L, Roche-Campo, F, Rialp, G, Forteza, C, Berrazueta, A, Martinez, E, Penuelas, O, Jara-Rubio, R, Mallat, J, Thevenin, D, Zogheib, E, Levrat, A, Porot, V, Bedock, B, Grech, L, Plantefeve, G, Badie, J, Besch, G, Pili-Floury, S, Guisset, O, Robine, A, Prat, G, Doise, J, Badet, M, Thouret, J, Just, B, Perbet, S, Lautrette, A, Souweine, B, Chabanne, R, Danguy des Déserts, M, Rigaud, J, Marchalot, A, Bele, N, Beague, S, Hours, S, Marque, S, Durand, M, Payen, J, Stoclin, A, Gaffinel, A, Winer, A, Chudeau, N, Tirot, P, Thyrault, M, Paulet, R, Aubrun, F, Guerin, C, Floccard, B, Rimmele, T, Argaud, L, Hernu, R, Crozon Clauzel, J, Wey, P, Bourdin, G, Pommier, C, Cueuille, N, de Varax, N, Marchi, E, Papazian, L, Jochmans, S, Monchi, M, Jaber, S, de Jong, A, Moulaire, V, Capron, M, Jarrige, L, Barberet, G, Lakhal, K, Rozec, B, Dellamonica, J, Robert, A, Bernardin, G, Danin, P, Raucoules, M, Runge, I, Foucrier, A, Hamada, S, Tesniere, A, Fromentin, M, Samama, C, Mira, J, Diehl, J, Mekontso Dessap, A, Arbelot, C, Demoule, A, Roche, A, Similowski, T, Ricard, J, Gaudry, S, Dreyfuss, D, de Montmolin, E, da Silva, D, Verdiere, B, Ardisson, F, Lemiale, V, Azoulay, E, Bruel, C, Tiercelet, K, Fartoukh, M, Voiriot, G, Hoffmann, C, Leclerc, T, Thille, A, Robert, R, Beduneau, G, Beuzelin, M, Tamion, F, Morel, J, Tremblay, A, Molliex, S, Amal, J, Meaudre, E, Goutorbe, P, Laffon, M, Gros, A, Nica, A, Barjon, G, Dahyot-Fizelier, C, Imzi, N, Gally, J, Real, N, Sauneuf, B, Souloy, X, Girbes, A, Tuinman, P, Schultz, M, Winters, T, Mijzen, L, Roekaerts, P, Vermeijden, W, Beishuizen, A, Trof, R, Corsten, S, Kesecioglu, J, Dieperink, W, Pickers, P, Roovers, N, Duque, M, Rua, F, Pereira de Figueired, A, Ramos, A, Fragoso, E, Azevedo, P, Gouveia, J, Costa E. Silva, Z, Silva, G, Chaves, S, Nobrega, J, Lopes, L, Valerio, B, Araujo, A, de Freitas, P, Bouw, M, Melao, M, Granja, C, Marcal, P, Fernandes, A, Joao, G, Maia, D, Spadaro, S, Volta, C, Citerio, G, Mauri, T, Alban, L, Pesenti, A, Mistraletti, G, Formenti, P, Tommasino, C, Tardini, F, Fumagalli, R, Colombo, R, Fossali, T, Catena, E, Todeschini, M, Gnesin, P, Cracchiolo, A, Palma, D, Tetamo, R, Albiero, D, Costantini, E, Raimondi, F, Coppadoro, A, Vascotto, E, Lusenti, F, Schã¤dler, D, Weiler, N, Karagiannidis, C, Petersson, J, Konrad, D, Kawati, R, Wessbergh, J, Valtysson, J, Rockstroh, M, Borgstrom, S, Larsson, N, Thunberg, J, Camsooksai, J, Briggs, N, Cuesta, J, Anwar, S, O’Brien, B, Barberis, L, Sturman, J, Karatzas, S, Piza, P, Sottiaux, T, Adam, J, Gawda, R, Gawor, M, Alqdah, M, Cohen, D, Baker, A, Ñamendys-Silva, S, Garcia-Guillen, F, Morocho Tutillo, D, Jibaja Vega, M, Zakalik, G, Pagella, G, and Marengo, J
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ARDS ,RECEIVING MECHANICAL VENTILATION ,Epidemiology ,medicine.medical_treatment ,cross-sectional studies ,RESPIRATORY-DISTRESS-SYNDROME ,vrouwelijk ,buikligging ,Critical Care and Intensive Care Medicine ,respiratory distress syndrome, adult/therapy ,law.invention ,Positive-Pressure Respiration ,Prone position ,0302 clinical medicine ,Mechanical ventilation ,prospectieve studies ,Randomized controlled trial ,law ,middle aged ,Medicine ,FAILURE ,adult/therapy ,humans ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,RANDOMIZED CONTROLLED-TRIAL ,respiratory distress syndrome ,3. Good health ,cross-sectionele studies ,ademnoodsyndroom ,aged ,female ,SURVIVAL ,middelbare leeftijd ,medicine.medical_specialty ,Pain medicine ,positieve druk uitademing ,NO ,03 medical and health sciences ,male ,mensen ,Anesthesiology ,ouderen ,METAANALYSIS ,business.industry ,MORTALITY ,030208 emergency & critical care medicine ,mannelijk ,CARE ,medicine.disease ,prospective studies ,EVOLUTION ,body regions ,030228 respiratory system ,Emergency medicine ,Observational study ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Introduction: While prone positioning (PP) has been shown to improve patient survival in moderate to severe acute respiratory distress syndrome (ARDS) patients, the rate of application of PP in clinical practice still appears low.Aim: This study aimed to determine the prevalence of use of PP in ARDS patients (primary endpoint), the physiological effects of PP, and the reasons for not using it (secondary endpoints).Methods: The APRONET study was a prospective international 1-day prevalence study performed four times in April, July, and October 2016 and January 2017. On each study day, investigators in each ICU had to screen every patient. For patients with ARDS, use of PP, gas exchange, ventilator settings and plateau pressure (Pplat) were recorded before and at the end of the PP session. Complications of PP and reasons for not using PP were also documented. Values are presented as median (1st-3rd quartiles).Results: Over the study period, 6723 patients were screened in 141 ICUs from 20 countries (77% of the ICUs were European), of whom 735 had ARDS and were analyzed. Overall 101 ARDS patients had at least one session of PP (13.7%), with no differences among the 4 study days. The rate of PP use was 5.9% (11/187), 10.3% (41/399) and 32.9% (49/149) in mild, moderate and severe ARDS, respectively (P = 0.0001). The duration of the first PP session was 18 (16-23) hours. Measured with the patient in the supine position before and at the end of the first PP session, PaO2/FIO2 increased from 101 (76-136) to 171 (118-220) mmHg (P = 0.0001) driving pressure decreased from 14 [11-17] to 13 [10-16] cmH(2)O (P = 0.001), and Pplat decreased from 26 [23-29] to 25 [23-28] cmH(2)O (P = 0.04). The most prevalent reason for not using PP (64.3%) was that hypoxemia was not considered sufficiently severe. Complications were reported in 12 patients (11.9%) in whom PP was used (pressure sores in five, hypoxemia in two, endotracheal tube-related in two ocular in two, and a transient increase in intracranial pressure in one).Conclusions: In conclusion, this prospective international prevalence study found that PP was used in 32.9% of patients with severe ARDS, and was associated with low complication rates, significant increase in oxygenation and a significant decrease in driving pressure.
- Published
- 2018
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