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Oxygenation response to prone positioning in pulmonary and extrapulmonary ARDS

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Various etiologic factors change clinical response, morbidity, and mortality rates in ARDS. In this study, we investigated the oxygenation response of pulmonary and extrapulmonary ARDS patients to the prone position.


Thirty-two ARDS patients (Group1: n=16 with pulmonary causes and Group2: n=16 with extrapulmonary causes) were evaluated retrospectively. ARDS was defined according to the criteria established by the American-European Consensus Conference on ARDS [1]. PaO2/FiO2 ratios, PaCO2, PCWP values in the supine position (baseline) and then the same values in the prone position at the 1st, 4th and 24th h were obtained from the medical records. ARDS, APACHE II, and MOF scores on admission, and the first day of prone positioning were calculated and compared. Statistical evaluations were performed by student t-test.


Murray, APACHE II and MOF scores were similar in both groups during admission and there was no difference in oxygenation response to prone positioning between two groups (Table 1). However, the MOF score was higher in extrapulmonary ARDS on the day of prone positioning. Mortality rate was higher in the extrapulmonary group and on discharge this group had higher Murray, APACHE II and MOF scores (Table 2).


Our retrospective data suggest that oxygenation response to prone positioning was similar in both groups, but mortality rates were higher in extrapulmonary ARDS patients, which correlates with MOF scores.

Table 1
Table 2


  1. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Le Gall JR, Morris A, Sprag R: American- European Consensus Conference on ARDS. Definition, mechanism, relevant outcomes and clinical trial coordination. Am J Respir Crit Care Med 1994, 149: 818-824.

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Akinci, O., Cetin, M., Ergin, P. et al. Oxygenation response to prone positioning in pulmonary and extrapulmonary ARDS. Crit Care 4 (Suppl 1), P126 (2000).

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