The effect of prone position for ventilator-associated pneumonia in adult patients: a systematic review and meta-analysis

Abstract

Abstract Background: The effect and safety of prone position (PP) in ventilator-associated pneumonia (VAP) patients was uncertain. We systematically reviewed the literature published to investigate whether PP benefits for patients with VAP compared with conventional supine position (SP). Methods: PubMed, EMbase, Cochrane Library, CNKI and WanFang Database were electronically searched to collect randomized controlled trials (RCTs) about the PP ventilation and SP ventilation in intensive care unit (ICU) patients from inception to May 2020. Meta-analysis was performed by Revan 5.3 software. Results: A total of 7 RCTs involving 1604 patients were included. Compared to regular SP ventilation, the PP ventilation group had no statistical significance in the four aspects. The results of subgroup analysis showed that the incidence of VAP and all-cause mortality were not affected by the patient's initial oxygenation index. However, the incidence of VAP tended to decrease when the duration of PP ventilation was less than 16 hours per day. Meanwhile, the all-cause mortality was significantly decreased while the daily time was more than 16 hours. Conclusions: Current evidence showed that the PP ventilation could not decrease the incidence of VAP, all-cause mortality, length of mechanical ventilation, and ICU stay. However, the daily duration of PP ventilation may have an impact on the incidence of VAP and all-cause mortality in critical patients.