Thesis

Prone Positioning in Acute Respiratory Distress Syndrome: A Retrospective Review

Statement of Problem Acute respiratory distress syndrome (ARDS) is a condition that causes irreversible damage to the lungs. High-quality supportive care is the only option for ARDS treatment. Although supportive care for ARDS patients has improved over the last few decades, prognosis is still poor with mortality estimates ranging from 40 to 60 percent (Villar et al., 2011; Zambon & Vincent, 2008). Recent evidence indicates that prone positioning not only improves oxygenation but significantly reduces mortality (Abroug et al., 2011; Guerin et al., 2013; Sud et al., 2010). This suggests that ARDS patients may have a better chance of survival if placed in a prone position. The associated patient risks and cost with prone positioning make this therapy debatable in the absence of unwavering prognostic improvement. Replication and further investigation of the relationship between prone positioning and the outcome of survival is essential for determining the best treatment regime for ARDS patients. Sources of Data Convenience sampling was the method used to select the patient population from a large metropolitan hospital system in San Diego County. Clinical information was extracted from medical records of individuals that were treated for ARDS within the time-period of January 2012 to August 2014. Conclusions Reached The independent variables of position placement (p=0.028) and stage of ARDS (p=0.006) were both significant predictors for the dependent variable of mortality in ARDS patients within the sample population (α= 0.05). The odds of mortality occurring in severe ARDS patients were 2.6 times greater than the odds of mortality occurring in moderate ARDS patients [OR 2.598 (95% CI 1.321 to 5.111)]. The odds of mortality occurring in supine patients was approximately 60 percent less than the odds of mortality occurring in prone positioned patients [OR 0.401 (95% CI 0.177 to 0.907)].

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