Abstract
The purpose of this meta-analysis was to compare the efficacy and safety of prone versus supine position ventilation for adult acute respiratory distress syndrome (ARDS) patients. The electronic databases of PubMed, Embase, and the Cochrane Library were systematically searched from their inception up to September 2020. The relative risks (RRs) and weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were employed to calculate pooled outcomes using the random-effects models. Twelve randomized controlled trials that had recruited a total of 2264 adults with ARDS were selected for the final meta-analysis. The risk of mortality in patients who received prone position ventilation was 13% lower than for those who received supine ventilation, but this effect was not statistically significant (RR: 0.87; 95% CI: 0.75–1.00; P = 0.055). There were no significant differences between prone and supine position ventilation on the duration of mechanical ventilation (WMD: −0.22; P = 0.883) or ICU stays (WMD: –0.39; P = 0.738). The pooled RRs indicate that patients who received prone position ventilation had increased incidence of pressure scores (RR: 1.23; P = 0.003), displacement of a thoracotomy tube (RR: 3.14; P = 0.047), and endotracheal tube obstruction (RR: 2.45; P = 0.001). The results indicated that prone positioning during ventilation might have a beneficial effect on mortality, though incidence of several adverse events was significantly increased for these patients.
Highlights
Our findings indicate that Acute respiratory distress syndrome (ARDS) patients that underwent ventilation with prone positioning might experience lower risk of mortality, shorter mechanical ventilation duration, and longer ICU stays, the pooled effect estimates suggest no significant differences between groups
A meta-analysis conducted by Sud et al involved 9 randomized controlled trials (RCTs) and found prone ventilation was associated with a reduced risk of mortality in patients with severe hypoxemia [6]
In 2014, they update this study and contained 11 RCTs. ey point out prone positioning could improve mortality for ARDS patients that received protective lung ventilation [36]
Summary
Acute respiratory distress syndrome (ARDS) is a serious disorder in critically ill patients that is characterized by disrupted endothelial barriers, abnormal alveolar epithelium, pulmonary vascular permeability, and protein-rich pulmonary edema [1]. e mortality of ARDS remains high, and the pooled mortality rate in our meta-analysis was 43%, ranging from 26% to 58% [2,3,4]. e mortality of severe ARDS exceeds 60%, low-volume, low-pressure ventilation strategies have been employed to reduce ventilator-induced lung injury [5,6,7,8]. erefore, efforts to limit mechanical lung injury during invasive ventilation are widely used for improving survival in ARDS patients [7].Prone position ventilation has been adopted in ARDS patients in order to improve oxygenation and lung recruitment [9]. e mechanisms included improved ventilation-perfusion matching, end-expiratory lung volume, and ventilator-induced lung injury [10, 11]. E mortality of severe ARDS exceeds 60%, low-volume, low-pressure ventilation strategies have been employed to reduce ventilator-induced lung injury [5,6,7,8]. Erefore, efforts to limit mechanical lung injury during invasive ventilation are widely used for improving survival in ARDS patients [7]. Prone position ventilation has been adopted in ARDS patients in order to improve oxygenation and lung recruitment [9]. Uncertainty remains regarding the differences in efficacy and safety for prone versus supine positioning in ventilation of adults with ARDS. Erefore, Emergency Medicine International this meta-analysis, based on published RCTs, was carried out to evaluate the efficacy and safety of prone versus supine position ventilation in patients with ARDS Uncertainty remains regarding the differences in efficacy and safety for prone versus supine positioning in ventilation of adults with ARDS. erefore, Emergency Medicine International this meta-analysis, based on published RCTs, was carried out to evaluate the efficacy and safety of prone versus supine position ventilation in patients with ARDS
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