Different Duration of Prone Position Treatment for Patients with Acute Respiratory Distress Syndrome in Intensive Care Unit Patients: A Prospective Randomized Clinical Study

Introduction: Prolonged prone positioning, exceeding 16 hours, has been associated with decreased mortality rates among patients diagnosed with moderate to severe acute respiratory distress syndrome (ARDS). Extending the duration of prone positioning may confer greater therapeutic benefits. This study aims to assess the clinical disparities between 16-hour and 24-hour prone positioning therapy in patients with moderate to severe ARDS. Methods: This prospective randomized clinical trial was conducted in the intensive care unit of a university-affiliated tertiary medical center. Patients were randomly assigned to receive either 16-hour or 24-hour prone positioning therapy. All participants followed a protocol incorporating low tidal volume and protective lung strategies. Results: Forty-five patients diagnosed with moderate to severe ARDS requiring mechanical ventilation, 21 were allocated to the 16-hour prone positioning group, while 24 were assigned to the 24-hour group. Findings revealed no significant differences in PaO2 / FiO2 ratios, driving pressure, or serum lactate levels between the two groups. The first session of prone positioning has significantly higher PaO2 / FiO2 improvement than the second session of prone positioning (). The 24-hour group displayed a tendency toward requiring fewer prone positioning sessions compared to the 16-hour group. Secondary endpoint did not significantly differ between the two groups. Conclusions: There is a trend suggesting that the 24-hour prone positioning group necessitates fewer sessions than the 16-hour group, potentially reducing clinical workload. The first session of prone position has better improvement of oxygenation than the second session of prone position.