[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Citations 0
March 3, 2010

Prone Positioning in Patients With Acute Respiratory Distress Syndrome

JAMA. 2010;303(9):832-833. doi:10.1001/jama.2010.183

To the Editor: The randomized controlled trial by Dr Taccone and colleagues1 studied prone positioning in patients with acute respiratory distress syndrome (ARDS). The article raises questions about cardiovascular alterations and treatment of sepsis in study patients.

Shock and hemodynamic instability make prone positioning more difficult and potentially less safe. Furthermore, hemodynamic alterations and vasoactive agents (such as α- and β-adrenergic agents used clinically, including norepinephrine, dopamine, and dobutamine) can change perfusion distribution in the lung, alter gas exchange, and worsen oxygenation. Thus, over time a patient could move out of a state of being ineligible for the trial, and could also move from a classification of moderate to severe hypoxemia, with no change in the underlying ARDS pathology.

First Page Preview View Large
First page PDF preview
First page PDF preview