Feasibility and Effectiveness of Prone Position in Morbidly Obese Patients With ARDS

Audrey de Jong (1, 2) , Nicolas Molinari (2) , Mustapha Sebbane (3) , Albert Prades (2) , Emmanuel Futier (4) , Boris Jung (1, 2) , Gerald Chanques (1, 2) , Samir Jaber (1, 2)

1 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
2 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
3 Département de Médecine d'Urgence
4 Service d'Anésthésie Réanimation [CHU Clermont-Ferrand]

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 5 .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 5 10, 30%). PaO2/FIO2 ratio increased signif- icantly 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; P5.03). Length of mechanical ventilation, ICU stay, and nosocomial infections did not differ significantly, but mortality at 90 days was sig- nificantly lower in obese patients (27% vs 48%, P,.05). Conclusions: PP seems safe in obese patients and may improve oxygenation more than in non- obese patients. Obese patients could be a subgroup of patients with ARDS who may benefit the most of PP.

Domaines: Médecine humaine et pathologie

Audrey de Jong, Nicolas Molinari, Mustapha Sebbane, Albert Prades, Emmanuel Futier, et al.. Feasibility and Effectiveness of Prone Position in Morbidly Obese Patients With ARDS. Chest, 2013, 6, pp.1554-1561. ⟨10.1378/chest.12-2115⟩. ⟨hal-02549932⟩