0
Original Research: Critical Care |

Feasibility and Effectiveness of Prone Position in Morbidly Obese Patients With ARDSProne Position in Obese Patients with ARDS: A Case-Control Clinical Study

Audrey De Jong, MD; Nicolas Molinari, PhD; Mustapha Sebbane, MD; Albert Prades; Nursing Fellow; Emmanuel Futier, MD; Boris Jung, MD; Gérald Chanques, MD; Samir Jaber, MD
Author and Funding Information

From the Intensive Care Unit and Transplantation Department (DAR B) (Drs De Jong, Sebbane, Futier, Jung, Chanques; Prof Jaber; and Mr Prades), Saint Eloi Hospital, University Hospital of Montpellier-INSERM U1046; and the Medical and Informatic Department (Dr Molinari), Lapeyronie University Hospital of Montpellier, UMR 729 MISTEA, Route de Ganges, Montpellier cedex 5, France.

Correspondence to: Prof Samir Jaber, Unité de Réanimation-Département d’Anesthésie-Réanimation “B”, University hospital, CHU de Montpellier Hopital Saint Eloi, 80, Avenue Augustin Fliche, 34295 Montpellier cedex 5, France; e-mail: s-jaber@chu-montpellier.fr


Funding/Support: This study was supported by the University Hospital of Montpellier.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(6):1554-1561. doi:10.1378/chest.12-2115
Text Size: A A A
Published online

Background:  Obese patients are at risk for developing atelectasis and ARDS. Prone position (PP) may reduce atelectasis, and it improves oxygenation and outcome in severe hypoxemic patients with ARDS, but little is known about its effect in obese patients with ARDS.

Methods:  Morbidly obese patients (BMI ≥ 35 kg/m2) with ARDS (Pao2/Fio2 ratio ≤ 200 mm Hg) were matched to nonobese (BMI < 30 kg/m2) patients with ARDS in a case-control clinical study. The primary end points were safety and complications of PP; the secondary end points were the effect on oxygenation (Pao2/Fio2 ratio at the end of PP), length of mechanical ventilation and ICU stay, nosocomial infections, and mortality.

Results:  Between January 2005 and December 2009, 149 patients were admitted for ARDS. Thirty-three obese patients were matched with 33 nonobese patients. Median (25th-75th percentile) PP duration was 9 h (6-11 h) in obese patients and 8 h (7-12 h) in nonobese patients (P = .28). We collected 51 complications: 25 in obese and 26 in nonobese patients. The number of patients with at least one complication was similar across groups (n = 10, 30%). Pao2/Fio2 ratio increased significantly more in obese patients (from 118 ± 43 mm Hg to 222 ± 84 mm Hg) than in nonobese patients (from 113 ± 43 mm Hg to 174 ± 80 mm Hg; P = .03). Length of mechanical ventilation, ICU stay, and nosocomial infections did not differ significantly, but mortality at 90 days was significantly lower in obese patients (27% vs 48%, P < .05).

Conclusions:  PP seems safe in obese patients and may improve oxygenation more than in nonobese patients. Obese patients could be a subgroup of patients with ARDS who may benefit the most of PP.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543