TY - JOUR T1 - Study of prone positioning to reduce ventilator-associated pneumonia in hypoxaemic patients JF - European Respiratory Journal JO - Eur Respir J SP - 795 LP - 804 DO - 10.1183/09031936.00057509 VL - 35 IS - 4 AU - R. Mounier AU - C. Adrie AU - A. Français AU - M. Garrouste-Orgeas AU - C. Cheval AU - B. Allaouchiche AU - S. Jamali AU - A. T. Dinh-Xuan AU - D. Goldgran-Toledano AU - Y. Cohen AU - E. Azoulay AU - J-F. Timsit AU - J-D. Ricard A2 - , Y1 - 2010/04/01 UR - http://erj.ersjournals.com/content/35/4/795.abstract N2 - The aim of the present study was to examine whether prone positioning (PP) affects ventilator associated-pneumonia (VAP) and mortality in patients with acute lung injury/adult respiratory distress syndrome. 2,409 prospectively included patients were admitted over 9 yrs (2000–2008) to 12 French intensive care units (ICUs) (OUTCOMEREA). The patients required invasive mechanical ventilation (MV) and had arterial oxygen tension/inspiratory oxygen fraction ratios <300 during the first 48 h. Controls were matched to PP patients on the PP propensity score (±10%), MV duration longer than that in PP patients before the first turn prone, and centre. VAP incidence was similar in the PP and control groups (24 versus 13 episodes·1,000 patient-days MV−1 respectively, p = 0.14). After adjustment, PP did not decrease VAP occurrence (HR 1.64 (95% CI 0.70–3.84); p = 0.25) but significantly delayed hospital mortality (HR 0.56 (95% CI 0.39–0.79); p = 0.001), without decreasing 28-day mortality (37% in both groups). Post hoc analyses indicated that PP did not protect against VAP but, when used for >1 day, might decrease mortality and benefit the sickest patients (Simplified Acute Physiology Score >50). In ICU patients with hypoxaemic acute respiratory failure, PP had no effect on the risk of VAP. PP delayed mortality without decreasing 28-day mortality. PP >1 day might decrease mortality, particularly in the sickest patients. ER -