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Prone positioning for acute respiratory failure improved short term oxygenation but not survival

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QUESTION: Does prone positioning for ≥ 6 hours each day for 10 days improve survival of patients with acute lung injury or the acute respiratory distress syndrome (ARDS)?


Randomised (allocation concealed), unblinded, controlled trial with 6 months of follow up.


28 intensive care units (ICUs) in Italy and 2 in Switzerland.


304 patients (mean age 58 y, 68% men) who were receiving mechanical ventilation and met the following modified criteria for acute lung injury or ARDS: ratio of partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2) ≤ 200 with a positive end expiratory pressure (PEEP) ≥ 5 cm of water, or a PaO2:FiO2 ratio ≤ 300 with a PEEP ≥ 10 cm water; radiographic evidence of …

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  • Source of funding: partial funding by Hill-rom Italy.

  • For correspondence: Dr L Gattinoni, Istituto di Anestesia e Rianimazione, Ospedale Maggiore Policlinico-IRCCS, Milan, Italy. gattinon{at}

  • Abstract and commentary appear in ACP Journal Club.