Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, Malacrida R, Di Giulio P, Fumagalli R, Pelosi P, Brazzi L, Latini R
Istituto di Anestesia e Rianimazione, Università di Milano, Ospedale Maggiore di Milano, Milan, Italy.
N Engl J Med. 2001 Aug 23;345(8):568-73. doi: 10.1056/NEJMoa010043.
Although placing patients with acute respiratory failure in a prone (face down) position improves their oxygenation 60 to 70 percent of the time, the effect on survival is not known.
In a multicenter, randomized trial, we compared conventional treatment (in the supine position) of patients with acute lung injury or the acute respiratory distress syndrome with a predefined strategy of placing patients in a prone position for six or more hours daily for 10 days. We enrolled 304 patients, 152 in each group.
The mortality rate was 23.0 percent during the 10-day study period, 49.3 percent at the time of discharge from the intensive care unit, and 60.5 percent at 6 months. The relative risk of death in the prone group as compared with the supine group was 0.84 at the end of the study period (95 percent confidence interval, 0.56 to 1.27), 1.05 at the time of discharge from the intensive care unit (95 percent confidence interval, 0.84 to 1.32), and 1.06 at six months (95 percent confidence interval, 0.88 to 1.28). During the study period the mean (+/-SD) increase in the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen, measured each morning while patients were supine, was greater in the prone than the supine group (63.0+/-66.8 vs. 44.6+/-68.2, P=0.02). The incidence of complications related to positioning (such as pressure sores and accidental extubation) was similar in the two groups.
Although placing patients with acute respiratory failure in a prone position improves their oxygenation, it does not improve survival.
尽管将急性呼吸衰竭患者置于俯卧（脸朝下）位能在60%至70%的时间内改善其氧合，但对生存率的影响尚不清楚。
在一项多中心随机试验中，我们将急性肺损伤或急性呼吸窘迫综合征患者的传统治疗（仰卧位）与一种预先设定的策略进行了比较，该策略是让患者每天俯卧位6小时或更长时间，持续10天。我们纳入了304例患者，每组152例。
在为期10天的研究期间，死亡率为23.0%，在重症监护病房出院时为49.3%，6个月时为60.5%。与仰卧组相比，俯卧组在研究期末的死亡相对风险为0.84（95%置信区间为0.56至1.27），在重症监护病房出院时为1.05（95%置信区间为0.84至1.32），6个月时为1.06（95%置信区间为0.88至1.28）。在研究期间，每天早晨患者仰卧时测量的动脉血氧分压与吸入氧分数之比的平均（±标准差）增加值，俯卧组大于仰卧组（63.0±66.8对44.6±68.2，P = 0.02）。两组中与体位相关的并发症（如压疮和意外拔管）发生率相似。
尽管将急性呼吸衰竭患者置于俯卧位可改善其氧合，但并不能提高生存率。
