PROSEVA trial in ARDS

Q: PROSEVA is considered a landmark trial for?

A) Small tidal volumes in ARDS
B) High vs low PEEP in ARDS
C) High vs low driving pressures in ARDS
D) Prone positioning in ARDS
E) Early vs late extubation in ARDS


Answer: D

The objective of the above question is to emphasie the need of knowing the major landmark trials in Medicine. When it comes to Acute Respiratory Distress Syndome (ARDS), few trials are extremely important to know which have impacted the basic clinical practices.

Prone positioning in ARDS has a long tortuous history. One of the trials which were able to settle the said issue was PROSEVA (Prone Positioning in Severe ARDS) trial published in June 2013. It was a fairly large trial of 466 patients evenly distributed between two arms. 

The 28-day mortality was 16.0% in the prone group and 32.8% in the supine group, with a hazard ratio of 0.39.

The unadjusted 90-day mortality was 23.6% in the prone group versus 41.0% in the supine group with a hazard ratio of 0.44.

You can read the full trial here:: https://www.nejm.org/doi/pdf/10.1056/nejmoa1214103

#Pulmonary
#ARDS


Reference:

Guérin C, and et al. for PROSEVA Study Group.  Prone positioning in severe acute respiratory distress syndrome. .N Engl J Med. 2013 Jun 6;368(23):2159-68. doi: 10.1056/NEJMoa1214103.