Intensive Care Medicine

, Volume 42, Issue 5, pp 871–878 | Cite as

Ventilator-associated pneumonia in ARDS patients: the impact of prone positioning. A secondary analysis of the PROSEVA trial

  • L. Ayzac
  • R. Girard
  • L. Baboi
  • P. Beuret
  • M. Rabilloud
  • J. C. Richard
  • C. GuérinEmail author



The goal of this study was to assess the impact of prone positioning on the incidence of ventilator-associated pneumonia (VAP) and the role of VAP in mortality in a recent multicenter trial performed on patients with severe ARDS.


An ancillary study of a prospective multicenter randomized controlled trial on early prone positioning in patients with severe ARDS. In suspected cases of VAP the diagnosis was based on positive quantitative cultures of bronchoalveolar lavage fluid or tracheal aspirate at the 104 and 107 CFU/ml thresholds, respectively. The VAP cases were then subject to central, independent adjudication. The cumulative probabilities of VAP were estimated in each position group using the Aalen–Johansen estimator and compared using Gray’s test. A univariate and a multivariate Cox model was performed to assess the impact of VAP, used as a time-dependent covariate for mortality hazard during the ICU stay.


In the supine and prone position groups, the incidence rate for VAP was 1.18 (0.86–1.60) and 1.54 (1.15–2.02) per 100 days of invasive mechanical ventilation (p = 0.10), respectively. The cumulative probability of VAP at 90 days was estimated at 46.5 % (27–66) in the prone group and at 33.5 % (23–44) in the supine group. The difference between the two cumulative probability curves was not statistically significant (p = 0.11). In the univariate Cox model, VAP was associated with an increase in the mortality rate during the ICU stay [HR 1.65 (1.05–2.61), p = 0.03]. HR increased to 2.2 (1.39–3.52) (p < 0.001) after adjustment for position group, age, SOFA score, McCabe score, and immunodeficiency.


In severe ARDS patients prone positioning did not reduce the incidence of VAP and VAP was associated with higher mortality.


ARDS Prone position Ventilator-associated pneumonia 


Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

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Supplementary material 1 (DOCX 14 kb)
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Supplementary material 2 (DOCX 19 kb)
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Supplementary material 3 (DOCX 11 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • L. Ayzac
    • 1
  • R. Girard
    • 2
  • L. Baboi
    • 3
  • P. Beuret
    • 4
  • M. Rabilloud
    • 5
    • 6
    • 7
    • 8
  • J. C. Richard
    • 3
    • 6
    • 7
    • 9
  • C. Guérin
    • 3
    • 6
    • 7
    • 10
    Email author
  1. 1.Centre de Coordination et de Lutte Contre les Infections Nosocomiales Sud-EstSaint Genis LavalFrance
  2. 2.Hospices Civils de Lyon, Service d’HygièneGroupement Hospitalier SudPierre BéniteFrance
  3. 3.Hospices Civils de Lyon, Service de Réanimation MédicaleGroupement Hospitalier NordLyonFrance
  4. 4.Service de Réanimation PolyvalenteCentre Hospitalier GénéralRoanneFrance
  5. 5.Hospices Civils de Lyon, Service de BiostatistiqueLyonFrance
  6. 6.Université de LyonLyonFrance
  7. 7.Université Lyon 1VilleurbanneFrance
  8. 8.CNRS, UMR 5558, Laboratoire de Biométrie et Biologie EvolutiveEquipe Biostatistique-SantéVilleurbanneFrance
  9. 9.Créatis INSERM 1044LyonFrance
  10. 10.Institut Mondor de Recherche Biomédicale INSERM 955 Eq 13CréteilFrance

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