دورية أكاديمية
Prone Positioning During Extracorporeal Membrane Oxygenation in Patients With Severe ARDS ; The PRONECMO Randomized Clinical Trial
| العنوان: | Prone Positioning During Extracorporeal Membrane Oxygenation in Patients With Severe ARDS ; The PRONECMO Randomized Clinical Trial |
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| المؤلفون: | Schmidt, Matthieu, Hajage, David, Lebreton, Guillaume, Dres, Martin, Guervilly, Christophe, Richard, Jean Christophe, Sonneville, Romain, Winiszewski, Hadrien, Muller, Gregoire, Beduneau, Gaëtan, Mercier, Emmanuelle, Roze, Hadrien, Lesouhaitier, Mathieu, Terzi, Nicolas, Thille, Arnaud W., Laurent, Isaura, Kimmoun, Antoine, Combes, Alain, Luyt, Charles Edouard, Hekimian, Guillaume, Brechot, Nicolas, Chommeloux, Juliette, Pineton de Chambrun, Marc, Saura, Ouriel, Levy, David, Lefevre, Lucie, Assouline, Benjamin, Bahroum, Petra, Gautier, Melchior, Leprince, Pascal, Juvin, Charles, Demondion, Pierre, Bergue, Elodie, Danial, Pichoy, Al-kabani, Hamed, Bounader, Karl, Schoell, Thibaut, D'Allesandro, Cosimo, Bureau, Côme, Le Marec, Julien, Mayaux, Julien, Decavèle, Maxens, Demoule, Alexandre, Deleris, Robin, Nemlaghi, Safaa, Lecronier, Marie, Capellier, Gilles, Piton, Gael, Belon, Francois, Vieille, Thibault |
| المصدر: | JAMA ; volume 330, issue 24, page 2343 ; ISSN 0098-7484 |
| بيانات النشر: | American Medical Association (AMA) |
| سنة النشر: | 2023 |
| الوصف: | Importance Prone positioning may improve outcomes in patients with severe acute respiratory distress syndrome (ARDS), but it is unknown whether prone positioning improves clinical outcomes among patients with ARDS who are undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO) compared with supine positioning. Objective To test whether prone positioning vs supine positioning decreases the time to successful ECMO weaning in patients with severe ARDS supported by VV-ECMO. Design, Setting, and Participants Randomized clinical trial of patients with severe ARDS undergoing VV-ECMO for less than 48 hours at 14 intensive care units (ICUs) in France between March 3, 2021, and December 7, 2021. Interventions Patients were randomized 1:1 to prone positioning (at least 4 sessions of 16 hours) (n = 86) or to supine positioning (n = 84). Main Outcomes and Measures The primary outcome was time to successful ECMO weaning within 60 days following randomization. Secondary outcomes included ECMO and mechanical ventilation–free days, ICU and hospital length of stay, skin pressure injury, serious adverse events, and all-cause mortality at 90-day follow-up. Results Among 170 randomized patients (median age, 51 [IQR, 43-59] years; n = 60 women [35%]), median respiratory system compliance was 15.0 (IQR, 10.7-20.6) mL/cm H 2 O; 159 patients (94%) had COVID-19–related ARDS; and 164 (96%) were in prone position before ECMO initiation. Within 60 days of enrollment, 38 of 86 patients (44%) had successful ECMO weaning in the prone ECMO group compared with 37 of 84 (44%) in the supine ECMO group (risk difference, 0.1% [95% CI, −14.9% to 15.2%]; subdistribution hazard ratio, 1.11 [95% CI, 0.71-1.75]; P = .64). Within 90 days, no significant difference was observed in ECMO duration (28 vs 32 days; difference, −4.9 [95% CI, −11.2 to 1.5] days; P = .13), ICU length of stay, or 90-day mortality (51% vs 48%; risk difference, 3.5% [95% CI, −12.7% to 19.7%]; P = .62). No serious adverse events were reported during the prone position ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1001/jama.2023.24491 |
| الإتاحة: | https://doi.org/10.1001/jama.2023.24491Test https://jamanetwork.com/journals/jama/articlepdf/2812529/jama_schmidt_2023_oi_230144_1706892934.94829.pdfTest |
| رقم الانضمام: | edsbas.718AF71B |
| قاعدة البيانات: | BASE |
| DOI: | 10.1001/jama.2023.24491 |
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