The PROSEVA trial shows improved survival with prone positioning in patients affected by moderate/severe ARDS. Prone positioning resulted effective in patients with moderate/severe ARDS persisting after a 12–24 hours stabilization period, admitted to centers with proven experience with prone position. Patients were ventilated with protective ventilation (6 ml/kg) and a PEEP of about 10 cm H2O. Prone position sessions lasted for at least 16 hours, and patients randomized to prone position were kept supine only if their PaO2/FiO2 consistently improved. Improved survival was not associated with improvement in pH, PaCO2, or PaO2; therefore a “response” to prone position is not necessarily a marker of improvement. Incidence of complications did not differ significantly between the two groups, except for cardiac arrests, which was higher in the supine group.
Change in cardiac output during Trendelenburg maneuver is a reliable predictor of fluid responsiveness in patients with acute respiratory distress syndrome in the prone position under protective ventilation
