The PROSEVA Study: A Gold Standard for Prone Positioning for the Critically ill

The PROSEVA Study: A Gold Standard for Prone Positioning for the Critically ill

In 2013, the New England Journal of Medicine published the study* titled “Prone Positioning in Severe Acute Respiratory Distress Syndrome.” The acronym PROSEVA (Proning Severe ARDS Patients) was used by the study group authors.

This study was the first randomized-controlled trial to find that prone positioning reduces mortality in patients with acute respiratory distress syndrome (ARDS). Some key aspects of this study led to the significant finding of reduction in mortality, which many facilities seek to mirror in their practices today.

First, the PROSEVA study enrolled patients early – within 36 hours of ARDS diagnosis and intubation/mechanical ventilation and once the patient met the parameters of a P/F ratio of <150, a PEEP ≥ 5, and FiO2 ≥ 60%. Once patients met inclusion criteria, they were monitored for 12–24 hours to ensure patients continued to be within the study inclusion parameters. Patients then were randomized to be in the prone position for a minimum of 16 hours per day, or in the supine position for the duration of the study. It is important to note that the physicians who took part in this trial utilized the same mechanical ventilation protocol.

Following this inclusion criteria, the study found that patients placed for a minimum of 16 hours prone per day had a reduction in mortality of 50% – the supine group mortality at 28 days was 32.8%, and the prone group mortality at 28 days was 16%. This mortality difference continued at 90 days as well. Some additional findings reported more ventilation-free days in the prone group, and increased incidence of cardiac arrests in the supine group.

After this study, many additional meta-analyses and national guidelines have supported the use of prone positioning as an important intervention for patients with ARDS. Many facilities throughout the country have adopted similar practices to the PROSEVA trial, utilizing prone positioning for patients for a minimum of 16 hours per day when ordered by a physician.

The Pronova-O₂ Automated Prone Therapy System provides a safe and efficient method for providing the prone position for critically ill patients. For additional information on automated prone positioning, please visit turnmedical.com or call 1-855-275-8876. Refer to Pronova-O₂ Instructions for Use for full prescribing information including risks.

Reference

* Guérin C., Reignier J., Richard J.-C., et al. Prone Positioning in Severe Acute Respiratory Distress Syndrome. N Engl J Med 2013; 368:2159-2168