33 Matching Annotations
  1. Mar 2023
    1. In conclusion, this trial showed that patientswith ARDS and severe hypoxemia (as confirmedby a Pao2:Fio2 ratio of <150 mm Hg, with anFio2 of ≥0.6 and a PEEP of ≥5 cm of water) canbenefit from prone treatment when it is usedearly and in relatively long sessions

      Prone positioning may be beneficial in a small group of patients

    2. ified according to ICU. Patients were randomly

      Computer randomisation removed human bias, stratification should allow for equal numbers of participants at allocated to each group at each site

    3. prospective, multicenter,randomized, controlled trial

      Prospective - watching for outcomes Multicenter - participants included in the study are from more that one site randomised - refers to the assignment of participants to a particular treatment group controlled - a group does not receive the independent variable being studied

    4. interval

      The probabilyty that 95% of the populaton will fall within this range

    5. The hazard ratio

      HR a measure of how often a particular event occurs in one group to another

    6. this multicenter, prospective, randomized, controlled trial, we randomly as-signed 466 patients with severe ARDS to undergo prone-positioning sessions of atleast 16 hours or to be left in the supine position.

      RCT

    7. 4±4 per patien

      What?

    8. the

      stratification doesn't seem to be great and the supine group appear to be sicker.

    9. 229 in the supine groupand 237

      some difference in number, could indicate issues with randomisation

    10. 466

      456 patients were required according to the power calculation

    11. The

      reduce bias

    12. Cox proportional-hazards re-gression,

      investigating the association between the survival time of patients and one or more predictor variables.

    13. An absolute dif-ference in mortality of 25 percentage points ormore between groups at the time of the interimanalysis was the only criterion for early trial ter-mination. There was no stopping rule for futility

      this was all decided in the study protocol prior to the reseach commencing

    14. e study would have 90% powerto detect an absolute reduction of 15 percentagepoints (to 45%) with prone positioning,

      the probabilty of finding a 15% difference between the 2 means

    15. redicted bodyweight,

      only predicted body weight, not actual. Obesity and low body weight are both likely to impact on patient outcomes.

    16. Details regarding themanagement of sedation and the use of neuro-muscular blocking agents

      this is always open to subjectivity

    17. ife-threatening hypoxemia

      could skew the results

    18. linician’s discretion

      i wonder if there was variability here

    19. 4 hours after the patientwas returned to the supine position.

      quite a short period of time, doesn't show whether proing has long-term effects on oxygenation

    20. articipating centers were given guidelines(see the Supplementary Appendix) to ensure stan-dardization of prone placement. Standard ICUbeds were used for all patients. Patients assignedto the supine group remained in a semirecumbent

      Efforts to standardise care other than intervention

    21. atients assigned to the prone group had to beturned to the prone position within the first hourafter randomization

      Seems very quick and could have led to safety incidences although none recorded. Did this mean that some patients were excluded because they were not proned in time?

    22. The trial was overseen by a steering commit-tee that met monthly

      good practice?

    23. Data collectors were aware of the study-group as-signments, but outcomes assessors were not

      some blinding occured

    24. Written informed consent was obtained after thepatients’ next of kin read the informational leaf-let.

      Proxy consent can cause issues. it isn't clear who provided the NoK with the leaflet and whether they had to time to think or were pressured to provide consent immediately

    25. protocol

      study protocol developed before the study commenced, should limit deviation from the precribed care etc.

    26. 26 ICUs in Franceand 1 in Spain,

      Can the care recieved here be generalised to the UK?

    27. less than 36 hours

      ?they wanted to look at early proning in patients with severe ARDS

    28. However, meta-analy-ses2,11 have suggested that survival is significantlyimproved with prone positioning as comparedwith supine positioning among patients with se-verely hypoxemic ARDS at the time of random-ization.

      ?effective in a very specific set of patients

    29. 2013

      2013 - pre-Covid

    30. CT00527813.

      a really good abstract that provides a clear and concise overview of the paper

    31. xcept for the incidence of cardiac arrests,which was higher in the supine group

      Interesting

    32. inclusion

      Clear outcome

    33. 0

      Provide a clear definition of severe ARDS