ARDS: PROSEVA (Proning Severe ARDS Patients)

Question 1

PROSEVA Clinical Question

Answer 1

Among patients with severe ARDS, does prone positioning reduce all-cause mortality at 28 days when compared to supine-only positioning?

Question 2

PROSEVA Bottom Line

Answer 2

Among patients with severe ARDS (P:F ratio <150 mmHg), prone positioning reduces 28-day mortality.

Question 3

PROSEVA Primary Outcome

Answer 3

All-cause mortality at 28 days

Question 4

PROSEVA Criticisms

Answer 4

1. Unclear if centers with less experience in prone positioning would have higher rates of complications
2. Unclear if an inclusion bias present as little data from excluded patients was collected
3. Fluid balance and catacholamine dosing were not measured or reported
4. Groups imbalanced based on heir SOFA score, NM blockade, vasopressor, and glucocorticoid use
5. Highly selected patients
6. Significant mortality difference may have been due to a decrease in deaths due to refractory shock. There was minimal difference in deaths due to hypoxemia.

Question 5

Are pressure ulcers more common in prone or supine positioning

Answer 5

prone