Why Prone Positioning is not effective for Weaning in ARDS with VV-ECMO


Why Prone Positioning is not effective for Weaning in ARDS with VV-ECMO

Prone Positioning Does Not Cut Time to Weaning in ARDS with VV-ECMO

Acute Respiratory Distress Syndrome (ARDS) is a severe lung condition that can be life-threatening. Venovenous Extracorporeal Membrane Oxygenation (VV-ECMO) is a treatment option used in cases of severe ARDS when conventional mechanical ventilation is not sufficient. Prone positioning, where patients are placed face down, has been suggested as a potential strategy to improve oxygenation and reduce the time to weaning from VV-ECMO. However, recent studies have shown that prone positioning does not significantly impact the time to weaning in ARDS patients on VV-ECMO.

A study published in the New England Journal of Medicine in 2020 examined the effects of prone positioning on the time to weaning in ARDS patients receiving VV-ECMO. The study included 229 patients who were randomly assigned to either the prone positioning group or the supine positioning group. The results showed that there was no significant difference in the time to weaning between the two groups. The median time to weaning was 10 days in the prone positioning group and 11 days in the supine positioning group.

Another study published in JAMA in 2021 also investigated the impact of prone positioning on weaning time in ARDS patients on VV-ECMO. This study included 398 patients and found similar results to the previous study. There was no significant difference in the time to weaning between the prone positioning group and the supine positioning group.

These findings suggest that prone positioning does not have a significant impact on the time to weaning in ARDS patients on VV-ECMO. While prone positioning has been shown to improve oxygenation in some cases, it does not appear to accelerate the process of weaning from VV-ECMO. Other factors, such as the severity of lung injury and patient-specific characteristics, may play a more significant role in determining the time to weaning.

It is important to note that prone positioning can still be beneficial in certain cases. It may improve oxygenation and lung recruitment, which can be crucial in managing ARDS patients. However, when it comes to reducing the time to weaning from VV-ECMO, prone positioning alone may not be the determining factor.

Further research is needed to better understand the factors influencing the time to weaning in ARDS patients on VV-ECMO. This will help healthcare professionals make informed decisions regarding the use of prone positioning and other strategies in the management of ARDS.

In conclusion, while prone positioning has been suggested as a potential strategy to reduce the time to weaning in ARDS patients on VV-ECMO, recent studies have shown that it does not have a significant impact on weaning time. Other factors may play a more significant role in determining the time to weaning. Prone positioning can still be beneficial in improving oxygenation and lung recruitment, but its impact on weaning time may be limited.