Chest
Original ResearchCritical CareFeasibility and Effectiveness of Prone Position in Morbidly Obese Patients With ARDS: A Case-Control Clinical Study
Section snippets
Study Design
Because of the strictly observational, noninterventional study design, which was an evaluation of the routine use of PP in an ICU, and because of the absence of modification in patient clinical management, the need for written consent was waived according to French law.22 The local scientific and ethics committee of Comite d'Organization et de Gestion de l'Anesthesie-Reanimation du Centre Hospitalier Universitaire de Montpellier approved the design of the study (project approval number:
Patient Characteristics
From January 2005 to December 2009, 2,543 patients were admitted to the ICU. Invasive mechanical ventilation was performed in 1,704 patients; 149 met ARDS criteria, and of these, 44 were obese and 105 were not. Thirty-five obese patients and 69 nonobese patients were turned to PP. Table 1 presents the main characteristics of the 104 patients with ARDS in whom PP was used before the matching selection. Among them, 33 obese and 60 nonobese patients were eligible for the matching process.
Discussion
The main findings of this study are that obese patients with ARDS can be treated effectively and safely in PP and that this strategy is associated with better outcomes. To our knowledge, it is the first study that specifically reports the routine application of PP in a population of obese patients with ARDS.
Only one case report on an obese patient with ARDS has been published, showing that turning over the patient in PP improved oxygenation.21 In previous studies of Mancebo et al,17 Fernandez
Acknowledgments
Author contributions: Prof Jaber had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr De Jong: contributed to data collection, data analysis, drafting and writing the manuscript, and served as principal author.
Dr Molinari: contributed to statistical methods and statistical data analysis, and read and approved the final manuscript.
Dr Sebbane: contributed to data analysis, manuscript review, read and
References (32)
- et al.
The prone position in ARDS patients. A clinical study
Chest
(1988) - et al.
Cytomegalovirus infection in critically ill patients: associated factors and consequences
Chest
(2005) - et al.
Characteristics and outcomes of patients who self-extubate from ventilatory support: a case-control study
Chest
(1997) - et al.
The prone position in acute respiratory distress syndrome: a critical systematic review [in French]
Ann Fr Anesth Reanim
(2007) - et al.
Body mass index is associated with the development of acute respiratory distress syndrome
Thorax
(2010) - et al.
Influence of body mass index on outcome of the mechanically ventilated patients
Thorax
(2011) - et al.
Use of extreme position changes in acute respiratory failure
Crit Care Med
(1976) - et al.
Improved oxygenation in patients with acute respiratory failure: the prone position
Am Rev Respir Dis
(1977) - et al.
Prone position in mechanically ventilated patients with severe acute respiratory failure
Am J Respir Crit Care Med
(1997) - et al.
Short-term effects of prone position in critically ill patients with acute respiratory distress syndrome
Intensive Care Med
(1997)
Effects of ventilation in ventral decubitus position on respiratory mechanics in adult respiratory distress syndrome
Intensive Care Med
Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury
Am J Respir Crit Care Med
Improvement in oxygenation by prone position and nitric oxide in patients with acute respiratory distress syndrome
Intensive Care Med
Effect of the prone position on patients with hydrostatic pulmonary edema compared with patients with acute respiratory distress syndrome and pulmonary fibrosis
Am J Respir Crit Care Med
Short-term effects of inhaled nitric oxide and prone position in pulmonary and extrapulmonary acute respiratory distress syndrome
Am J Respir Crit Care Med
Effect of prone positioning on the survival of patients with acute respiratory failure
N Engl J Med
Cited by (96)
Obesity and Extracorporeal Membrane Oxygenation (ECMO): Analysis of Outcomes
2024, Journal of Cardiothoracic and Vascular AnesthesiaParallel Venovenous Extracorporeal Membrane Oxygenation Circuits for Refractory Hypoxemia in a Super-Super-Obese Patient
2023, Journal of Cardiothoracic and Vascular AnesthesiaIs BMI Associated with COVID-19 Severity? A Retrospective Observational Study
2023, Current Medicinal ChemistryVentilation of the patient with obesity
2022, Anesthesie et ReanimationWhat Works in a Patient With Acute Respiratory Distress Syndrome?
2022, Evidence-Based Practice of AnesthesiologyManual proning of a morbidly obese COVID-19 patient: A case report
2022, Australian Critical CareCitation Excerpt :Some centres deem the manual proning of an obese patient too dangerous,10 while others report it as safe and feasible.4,6 De Jong et al.4 described a similar manual proning approach in morbidly obese patients. However, important practical aspects were not mentioned in the publication.
Funding/Support: This study was supported by the University Hospital of Montpellier.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.