A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study

C Guérin; P Beuret; J Constantin; G Bellani; P Garcia-Olivares; O Roca; J Meertens; P Azevedo Maia; T Becher; J Peterson; A Larsson; M Gurjar; Z Hajjej; F Kovari; A Assiri; E Mainas; M Hasan; D Morocho-Tutillo; L Baboi; J Chrétien; G François; L Ayzac; L Chen; L Brochard; A Mercat; Zied Hajjej; Walid Sellami; M Ferjani; Mohan Gurjar; Amer Assiri; Ali Al Bshabshe; Ghaleb Almekhlafi; Yasser Mandourah; Mohd Hasan; Vineya Rai; M Marzida; Virgilio Corcoles Gonzalez; Rafael Sanchez Iniesta; Pablo Garcia; Manuel Garcia-Montesinos De La Peña; Adriana Garcia Herrera; Oriol Roca; Marina Garcia-de-Acilu; Joan Ramon Masclans Enviz; Jordi Mancebo; Sarah Heili; Antonio Artigas Raventos; Lluís Blanch Torra; Ferran Roche-Campo; Gemma Rialp; Catalina Forteza; Ana Berrazueta; Esther Martinez; Oscar Penuelas; Ruben Jara-Rubio; Jihad Mallat; D Thevenin; Elie Zogheib; Alain Mercat; Albrice Levrat; Veronique Porot; B Bedock; Ludovic Grech; Gaetan Plantefeve; Julio Badie; Guillaume Besch; Sébastien Pili-Floury; Olivier Guisset; Adrien Robine; Gwenael Prat; Jean-Marc Doise; Michel Badet; J Thouret; Bernard Just; Sébastien Perbet; Alexandre Lautrette; B Souweine; Russell Chabanne; Marc Danguy Des Déserts; Jean-Philippe Rigaud; Antoine Marchalot; J Rigaud; Nicolas Bele; Sébastien Beague; Sandrine Hours; Sophie Marque; Michel Durand; J Payen; Annabelle Stoclin; Alain Gaffinel; Arnaud Winer; Nicolas Chudeau; Patrice Tirot; Martial Thyrault; Rémi Paulet; M Thyrault; Frederic Aubrun; Claude Guerin; Bernard Floccard; T Rimmele; Laurent Argaud; Romain Hernu; Jullien Crozon Clauzel; Pierre-François Wey; Gael Bourdin; C Pommier; Nadège Cueuille; De Varax; Elisa Marchi; L Papazian; Sebastien Jochmans; M Monchi; Samir Jaber; Audrey De Jong; Valerie Moulaire; Matthieu Capron; L Jarrige; Guillaume Barberet; Karim Lakhal; B Rozec; Jean Dellamonica; Robert Alexandre; G Bernardin; Pierre-Eric Danin; M Raucoules; Isabelle Runge; Arnaud Foucrier; Sophie Hamada; Antoine Tesniere; Mélanie Fromentin; C Samama; Mira Jean-Paul; Jean-Luc Diehl; Armand Dessap; Charlotte Arbelot; Alexandre Demoule; Anne Roche; T Similowski; Jean-Damien Ricard; Stéphane Gaudry; D Dreyfuss; Etienne de Montmolin; Daniel Da Silva; B Verdiere; Fanny Ardisson; Virginie Lemiale; Elie Azoulay; Cédric Bruel; Kelly Tiercelet; Muriel Fartoukh; Guillaume Voiriot; Clement Hoffmann; T Leclerc; Arnaud Thille; Robert Réné; Pascal Beuret; Gaëtan Beduneau; Marion Beuzelin; F Tamion; Jérôme Morel; Aymeric Tremblay; S Molliex; Amal Jean-Michel; Eric Meaudre; Philippe Goutorbe; Marc Laffon; Antoine Gros; Alexandru Nica; Genevieve Barjon; Claire Dahyot-Fizelier; Nadia Imzi; Josette Gally; Real; Bertrand Sauneuf; Xavier Souloy; Armand Girbes; Pieter Tuinman; Marcus Schultz; Tineke Winters; Lisa Mijzen; P M H J Roekaerts; Wytze Vermeijden; Albertus Beishuizen; R Trof; Stijn Corsten; Jozef Kesecioglu; John Meertens; Wim Dieperink; Peter Pickers; Noortje Roovers; Paulo Maia; Melanie Duque; Fernando Rua; António Manuel Pereira De Figueired; Armindo Ramos; Elsa Fragoso; Pilar Azevedo; Joao Gouveia; Zélia Costa e Silva; Goncalo Silva; Susana Chaves; J Nobrega; Luís Lopes; Bernardino Valerio; Ana Araujo; Paulo Telles de Freitas; Maria Bouw; Maria Melao; C Granja; Paulo Marcal; Antero Fernandes; Gonçalves Pereira Joao; Dionísio Faria Maia; Savino Spadaro; Carlo Volta; Giacomo Bellani; G Citerio; Tommaso Mauri; Laura Alban; A Pesenti; Giovanni Mistraletti; Paolo Formenti; C Tommasino; Francesca Tardini; R Fumagalli; Riccardo Colombo; Tommaso Fossali; E Catena; Manuel Todeschini; Paolo Gnesin; Andrea Neville Cracchiolo; Daniela Palma; R Tetamo; Daniela Albiero; Elena Costantini; F Raimondi; Andrea Coppadoro; Ettore Vascotto; F Lusenti; Tobias Becher; Dirk Schädler; N Weiler; Christian Karagiannidis; Johan Petersson; D Konrad; Rafael Kawati; Joanna Wessbergh; J Valtysson; Matthias Rockstroh; Sten Borgstrom; Niklas Larsson; J Thunberg; Julie Camsooksai; Briggs; Ferenc Kovari; J Cuesta; Sibs Anwar; B O’Brien; Luigi Barberis; J Sturman; Efstratios Mainas; S Karatzas; Petr Piza; Thierry Sottiaux; J Adam; Ryszard Gawda; Maen Gawor; M Alqdah; D Cohen; Laurent Brochard; A Baker; Silvio Ñamendys-Silva; Francisco Garcia-Guillen; Diego Rolando Morocho Tutillo; Manuel Vega; Graciela Zakalik; Gonzalo Pagella; J Marengo; ESICM Trials Grp

doi:10.1007/s00134-017-4996-5

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A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study

Journal article

Peer reviewed

A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study

C Guérin, P Beuret, J Constantin, G Bellani, P Garcia-Olivares, O Roca, J Meertens, P Azevedo Maia, T Becher, J Peterson, …

Intensive care medicine, Vol.44(1), pp.22-37

01/01/2018

DOI: https://doi.org/10.1007/s00134-017-4996-5

PMID: 29218379

Abstract

Complications

Epidemiology

Gas exchange

Hypoxemia

Intensive care

Intracranial pressure

Oxygenation

Patients

Physiological effects

Position measurement

Pressure

Prone position

Quartiles

Respiratory distress syndrome

Supine position

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] cmH2O (P = 0.001), and Pplat decreased from 26 [23–29] to 25 [23–28] cmH2O (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.

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Title: A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study
Creators - without role: C Guérin - Hôpital de la Croix-Rousse
P Beuret - Réanimation polyvalente Roanne, Roanne, France
J Constantin - University of Clermont Auvergne
G Bellani
P Garcia-Olivares - Hospital General Universitario Gregorio Marañón
O Roca - Instituto de Salud Carlos III
J Meertens
P Azevedo Maia
T Becher - University Hospital Schleswig-Holstein
J Peterson - Karolinska Institutet
A Larsson - Sanjay Gandhi Post Graduate Institute of Medical Sciences
M Gurjar - Sanjay Gandhi Post Graduate Institute of Medical Sciences
Z Hajjej - Military Hospital of Tunis
F Kovari - North Middlesex University Hospital NHS Trust
A Assiri - Asir Central Hospital
E Mainas - Hippokrateion General Hospital of Athens, Athens, Greece
M Hasan
D Morocho-Tutillo - Hospital de Especialidades
L Baboi - Hôpital de la Croix-Rousse
J Chrétien
G François - European Society of Intensive Care Medicine
L Ayzac - Centre de coordination et de lutte contre les infections nosocomiales (C-CLIN) Sud-Est, Pierre Bénite, France
L Chen - St. Michael's Hospital
L Brochard - St. Michael's Hospital
A Mercat - Université d'Angers
Zied Hajjej - Military Hospital of Tunis
Walid Sellami
M Ferjani
Mohan Gurjar - Sanjay Gandhi Post Graduate Institute of Medical Sciences
Amer Assiri - Asir Central Hospital
Ali Al Bshabshe
Ghaleb Almekhlafi
Yasser Mandourah
Mohd Hasan
Vineya Rai
M Marzida
Virgilio Corcoles Gonzalez
Rafael Sanchez Iniesta
Pablo Garcia
Manuel Garcia-Montesinos De La Peña
Adriana Garcia Herrera
Oriol Roca - Instituto de Salud Carlos III
Marina Garcia-de-Acilu
Joan Ramon Masclans Enviz
Jordi Mancebo
Sarah Heili
Antonio Artigas Raventos
Lluís Blanch Torra
Ferran Roche-Campo
Gemma Rialp
Catalina Forteza
Ana Berrazueta
Esther Martinez
Oscar Penuelas
Ruben Jara-Rubio
Jihad Mallat
D Thevenin
Elie Zogheib
Alain Mercat - Université d'Angers
Albrice Levrat
Veronique Porot
B Bedock
Ludovic Grech
Gaetan Plantefeve
Julio Badie
Guillaume Besch
Sébastien Pili-Floury
Olivier Guisset
Adrien Robine
Gwenael Prat
Jean-Marc Doise
Michel Badet
J Thouret
Bernard Just
Sébastien Perbet
Alexandre Lautrette
B Souweine
Russell Chabanne
Marc Danguy Des Déserts
Jean-Philippe Rigaud
Antoine Marchalot
J Rigaud
Nicolas Bele
Sébastien Beague
Sandrine Hours
Sophie Marque
Michel Durand
J Payen
Annabelle Stoclin
Alain Gaffinel
Arnaud Winer
Nicolas Chudeau
Patrice Tirot
Martial Thyrault
Rémi Paulet
M Thyrault
Frederic Aubrun
Claude Guerin - Hôpital de la Croix-Rousse
Bernard Floccard
T Rimmele
Laurent Argaud
Romain Hernu
Jullien Crozon Clauzel
Pierre-François Wey
Gael Bourdin
C Pommier
Nadège Cueuille
De Varax
Elisa Marchi
L Papazian
Sebastien Jochmans
M Monchi
Samir Jaber
Audrey De Jong
Valerie Moulaire
Matthieu Capron
L Jarrige
Guillaume Barberet
Karim Lakhal
B Rozec
Jean Dellamonica
Robert Alexandre
G Bernardin
Pierre-Eric Danin
M Raucoules
Isabelle Runge
Arnaud Foucrier
Sophie Hamada
Antoine Tesniere
Mélanie Fromentin
C Samama
Mira Jean-Paul
Jean-Luc Diehl
Armand Dessap
Charlotte Arbelot
Alexandre Demoule
Anne Roche
T Similowski
Jean-Damien Ricard
Stéphane Gaudry
D Dreyfuss
Etienne de Montmolin
Daniel Da Silva
B Verdiere
Fanny Ardisson
Virginie Lemiale
Elie Azoulay
Cédric Bruel
Kelly Tiercelet
Muriel Fartoukh
Guillaume Voiriot
Clement Hoffmann
T Leclerc
Arnaud Thille
Robert Réné
Pascal Beuret - Réanimation polyvalente Roanne, Roanne, France
Gaëtan Beduneau
Marion Beuzelin
F Tamion
Jérôme Morel
Aymeric Tremblay
S Molliex
Amal Jean-Michel
Eric Meaudre
Philippe Goutorbe
Marc Laffon
Antoine Gros
Alexandru Nica
Genevieve Barjon
Claire Dahyot-Fizelier
Nadia Imzi
Josette Gally
Real
Bertrand Sauneuf
Xavier Souloy
Armand Girbes
Pieter Tuinman
Marcus Schultz
Tineke Winters
Lisa Mijzen
P M H J Roekaerts
Wytze Vermeijden
Albertus Beishuizen
R Trof
Stijn Corsten
Jozef Kesecioglu
John Meertens
Wim Dieperink
Peter Pickers
Noortje Roovers
Paulo Maia - Centro Hospitalar do Porto
Melanie Duque
Fernando Rua
António Manuel Pereira De Figueired
Armindo Ramos
Elsa Fragoso
Pilar Azevedo
Joao Gouveia
Zélia Costa e Silva
Goncalo Silva
Susana Chaves
J Nobrega
Luís Lopes
Bernardino Valerio
Ana Araujo
Paulo Telles de Freitas
Maria Bouw
Maria Melao
C Granja
Paulo Marcal
Antero Fernandes
Gonçalves Pereira Joao
Dionísio Faria Maia
Savino Spadaro
Carlo Volta
Giacomo Bellani
G Citerio - University of Milano-Bicocca
Tommaso Mauri
Laura Alban
A Pesenti
Giovanni Mistraletti
Paolo Formenti
C Tommasino
Francesca Tardini
R Fumagalli
Riccardo Colombo
Tommaso Fossali
E Catena
Manuel Todeschini
Paolo Gnesin
Andrea Neville Cracchiolo
Daniela Palma
R Tetamo
Daniela Albiero
Elena Costantini
F Raimondi
Andrea Coppadoro
Ettore Vascotto
F Lusenti
Tobias Becher - University Hospital Schleswig-Holstein
Dirk Schädler
N Weiler
Christian Karagiannidis
Johan Petersson
D Konrad
Rafael Kawati
Joanna Wessbergh
J Valtysson
Matthias Rockstroh
Sten Borgstrom
Niklas Larsson
J Thunberg
Julie Camsooksai
Briggs
Ferenc Kovari - North Middlesex University Hospital NHS Trust
J Cuesta
Sibs Anwar
B O’Brien
Luigi Barberis
J Sturman
Efstratios Mainas - Hippokrateion General Hospital of Athens, Athens, Greece
S Karatzas
Petr Piza
Thierry Sottiaux
J Adam
Ryszard Gawda
Maen Gawor
M Alqdah
D Cohen
Laurent Brochard - St. Michael's Hospital
A Baker
Silvio Ñamendys-Silva
Francisco Garcia-Guillen
Diego Rolando Morocho Tutillo
Manuel Vega
Graciela Zakalik
Gonzalo Pagella
J Marengo
ESICM Trials Grp
Publication Details: Intensive care medicine, Vol.44(1), pp.22-37
Publisher: Springer Nature B.V
Identifiers: 9922367008331
Academic Unit: King Khalid University
Language: English
Resource Type: Journal article