Impact of Prone Positioning on Mortality and Recovery in Adult ICU Patients with Acute Respiratory Distress Syndrome: A Retrospective Cohort Study

Authors

Ammar O. Alselmi, Sami H. B. Alossaimi, Abdulrahman M. Alahmari, Abdullah A. AlShehr

Abstract

Background: Prone positioning has been recommended as a treatment strategy for patients with Acute Respiratory Distress Syndrome (ARDS), but its effectiveness and associated complications in clinical practice require further investigation.

Objective: This study aimed to evaluate the impact of prone positioning on mortality, duration of mechanical ventilation, length of ICU stay, and incidence of complications in ARDS patients in adult ICUs.

Methods: This retrospective cohort study included 320 ARDS patients admitted to the ICUs of the National Guard Hospital from January 2018 to December 2022. Patients were divided into prone (n=160) and supine (n=160) groups. Data on demographics, clinical characteristics, treatment details, and outcomes were collected and analyzed.

Results: The prone positioning group showed significantly lower 28-day mortality (21.3% vs. 35.6%, p=0.003) and 90-day mortality (28.8% vs. 43.1%, p=0.007) compared to the supine group. Additionally, the prone group had shorter durations of mechanical ventilation (10.4 ± 3.6 days vs. 13.7 ± 4.2 days, p<0.001) and ICU stays (14.2 ± 5.1 days vs. 17.8 ± 6.4 days, p<0.001). Oxygenation improved more in the prone group at 48 hours (PaO2/FiO2 ratio: 200 ± 60 mmHg vs. 160 ± 50 mmHg, p<0.001). The incidence of pressure sores was higher in the prone group (15% vs. 7.5%, p=0.04), while ventilator-associated pneumonia was lower (10% vs. 18%, p=0.03).

Conclusions: Prone positioning significantly reduces mortality and enhances recovery in ARDS patients, although it is associated with an increased risk of pressure sores. Further research is needed to optimize prone positioning protocols and minimize complications.

Keywords

Prone positioning, ARDS, ICU, mortality, mechanical ventilation, complications

Impact of Prone Positioning on Mortality and Recovery in Adult ICU Patients with Acute Respiratory Distress Syndrome: A Retrospective Cohort Study. Ammar O. Alselmi, Sami H. B. Alossaimi, Abdulrahman M. Alahmari, Abdullah A. AlShehr. 2022. IJIRCT, Volume 8, Issue 3. Pages 1-7. https://www.ijirct.org/viewPaper.php?paperId=2407053