This work was supported by the 2017 Guangdong Medical Research Fund Project (grant no. The subgroup analyses for mortality were then performed according to sample size, mean age, percentage male, duration of intervention, protective lung ventilation, and study quality. However, these results were based on a smaller number of included trials, and this result needs to be verified by a large-scale RCT. 5 Typically, patients remain supine during mechanical ventilation; however, prone positioning has been used for the treatment of ARDS since the 1970s. Review articles are excluded from this waiver policy. Mechanical ventilation is widely used to improve oxygenation and reduce harmful effects in ARDS patients, though whether prone positioning during ventilation can improve clinical endpoints versus supine positioning remains unclear. Moreover, we noted that prone versus supine positioning was associated with lower risk of mortality when the mean age of the patients was <60.0 years, the percentage of male patients was <70.0%, or intervention was used as protective lung ventilation. The numbers of studies available for mechanical ventilation duration and ICU stays were six (7 cohorts) and six (7 cohorts), respectively. P:F ratio <150 2. In 2014, they update this study and contained 11 RCTs. Mora-Arteaga et al. FiO2 >60% 4. Moreover, the risk of pressure scores, displacement of a thoracotomy tube, and endotracheal tube obstruction were significantly increased in ARDS patients received prone positioning. PubMed, Embase, and the Cochrane Library were searched from their inception up to September 2020, and the following searching terms were combined by AND or OR: body posture, body position, prone position, prone positioning, ARDS, respiratory failure, and lung injury. Featured in the book,”AACN Procedure Manual for High Acuity, Progressive, and Critical Care.7th ed. Moreover, patients that received prone positioning could had increased risk of pressure ulcers and major airway problems [38]. V distribution is independent of posture. Numerous randomized controlled trials (RCTs) comparing prone position ventilation with supine positioning have been conducted, and the results are varied. Prone position ventilation has been adopted in ARDS patients in order to improve oxygenation and lung recruitment [9]. Copyright © 2020, the American Society of Anesthesiologists, Inc. All Rights Reserved. The prone scan showed a partial recovery of the aerated lung parenchyma in the right inferior lobe with a small area of residual consolidation in the posterior segment of the right lower lobe. 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 adverse events are also summarized between prone and supine positioning for ARDS patients. There were no significant differences between prone and supine position ventilation on the duration of mechanical ventilation (WMD: −0.22; = 0.883) or ICU stays (WMD: –0.39; = 0.738). These findings should be verified by further large-scale RCTs. A total of 363 studies were identified from the initial electronic database search, and 183 studies remained after removing duplicate publications. Prone positioning is known to improve the PaO2/FiO2 ratio and reduce mortality in patients with ARDS managed in the critical care setting. ARDS patients that received prone position ventilation could experience increased risk of pressure scores, displacement of a thoracotomy tube, and endotracheal tube obstruction. Copyright © 2020 Zanfeng Cao et al. Several strengths of this study should be highlighted: (1) the selection and concerning confounder biases were lower because this analysis was based on RCTs; (2) this study utilized a large sample size, and the results are more robust than individual trials; and (3) stratified analyses based on patients’ characteristics were conducted, which allows us to obtain more exploratory results. Elsevier; 2011”, procedure 19 offers knowledge on pronation therapy. Anesthesiology 2020; 133:1155–1157 doi: https://doi.org/10.1097/ALN.0000000000003511, PRONE positioning is a simple method to improve oxygenation in ventilated patients with acute respiratory distress syndrome (ARDS).1 Potential explanations are reduction of ventilation/perfusion mismatch, a more homogeneous distribution of transpulmonary pressure along the ventral-to-dorsal axis, and recruitment of nonaerated dorsal lung regions of the lung, with an increase in lung volume.2 Many of these mechanisms could also apply to awake patients with ARDS by COVID-19.3. Subgroup analyses indicated that prone versus supine positioning was associated with lower risk of mortality if the mean age of patients was <60.0 years, the percentage of male patients was <70.0%, or intervention was used as protective lung ventilation (Table 3). However, the limitations of these studies included several other efficacy and safety outcomes were not calculated, or subgroup analyses for the risk of mortality according to other patients’ characteristics were not presented. The sensitivity analyses indicated that prone versus supine positioning might be associated with shorter mechanical ventilation duration and longer ICU stays (Figures 5 and 6). Overall, a total of 2264 adults with ARDS from 12 RCTs were included in this study, and the sample sizes ranged from 16 to 791. However, several limitations should also be acknowledged: (1) substantial heterogeneity was detected for several outcomes, which could not be interpreted in subgroup analyses; (2) the analysis of this study was based on published articles, and unpublished data were not available; and (3) the background therapies for ARDS patients were not known, which also affect the prognosis of ARDS. The pooled results suggest that the risk of mortality was reduced by 13% for prone versus supine position ventilation, though this reduced risk was not statistically significant (RR: 0.87; 95% CI: 0.75–1.00; = 0.055; Figure 2). The mechanisms included improved ventilation-perfusion matching, end-expiratory lung volume, and ventilator-induced lung injury [10, 11]. STATA software was used for all of statistical analyses in this study (version 12.0, Stata Corporation, College Station, TX, USA). TV <=6cc/kg PBW 3. The usual practice is to position the newborn in supine (face-up) position during ventilation. Therefore, 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. Thus, that it is dependent at both postures. The pooled effect estimates were calculated and applied to the random-effects model (the DerSimonian–Laird method) [14, 15]. The differences between subgroups were assessed by using the interaction P test [19]. At this point, it’s likely that intubation and mechanical ventilation will be … We identified all relevant trials using the following techniques: electronic searches of MEDLINE, EMBASE, and CENTRAL (from inception to November We are committed to sharing findings related to COVID-19 as quickly as possible. The pooled RRs indicate that patients who received prone position ventilation had increased incidence of pressure scores (RR: 1.23; = 0.003), displacement of a thoracotomy tube (RR: 3.14; = 0.047), and endotracheal tube obstruction (RR: 2.45; = 0.001). The heterogeneity test indicated potentially significant heterogeneity (I2 = 40.5; = 0.079). The treatment effectiveness of prone versus supine position ventilation were assigned as dichotomous and continuous data, and the relative risks (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated before data pooling. [22] or Guérin et al. Munshi et al. Finally, the treatment effectiveness of prone versus supine positioning on the risk of mortality could affect by percentage male, and whether used as protective lung ventilation. Although not statistically significant, lower ICU mortality was observed among patients who underwent prone ventilation (43% vs. 58%, p=0.12). Sign up here as a reviewer to help fast-track new submissions. A meta-analysis conducted by Alsaghir and Martin contained five studies and found that prone positioning did not yield additional benefits with regard to mortality, whereas it improved oxygenation as compared with supine positioning. This site uses cookies. Prone versus supine position ventilation on mechanical ventilation duration. In 1978, Rehder et al. The collected variables included: first author’s surname, publication year, country, sample size, mean age, percentage of male patients, mean partial pressure of arterial oxygen (PaO2), fractional concentration of inspired oxygen (FIO2), mean positive end-expiratory pressure (PEEP), mean FIO2, duration of ARDS, duration of prone positioning, protective lung ventilation, and reported outcomes. However, it is not certain whether other positions, for example, “face-down” (prone position), could be more advantageous for breathing or other pursuits, including survival. That meta-analysis of 11 RCTs indicated that prone position ventilation significantly reduced the risk of mortality in severe ARDS patients or in patients who received sufficient duration of prone positioning. These conclusions are not stable and could be altered by excluding individual trials. Overall, patients that received prone position ventilation were associated with greater risk of pressure scores (RR: 1.23; 95% CI: 1.07–1.42; = 0.003), displacement of a thoracotomy tube (RR: 3.14; 95% CI: 1.02–9.69; = 0.047), and endotracheal tube obstruction (RR: 2.45; 95% CI: 1.42–4.24; = 0.001) than those received supine position ventilation. This study was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement [12]. The Jadad scale, taking into consideration randomization, blinding, allocation concealment, withdrawals and dropouts, and use of intention-to-treat analysis, was applied to assess the quality of included studies [13]. These quantitative analyses contained 2264 adults with ARDS across a broad range of patient characteristics. The inclusion criteria included: (1) patients, adults with ARDS; (2) intervention, prone position; (3) control, supine position; (4) outcomes, efficacy outcomes including mortality, mechanical ventilation duration, and ICU stays, and the safety outcomes, including any adverse events reported ≥2 studies; and (5) study design: RCT. Heterogeneity tests were conducted using I2 and Q statistic, and I2 ≥ 50.0% or < 0.10 was regarded as significant heterogeneity [16, 17]. A systematic review and metaanalysis,”, L. Munshi, L. Del Sorbo, N. K. J. Adhikari et al., “Prone position for acute respiratory distress syndrome. The remaining 28 studies were retrieved for full-text evaluation, and 12 RCTs were selected for final analyses [22–33]. The mortality of severe ARDS exceeds 60%, although low-volume, low-pressure ventilation strategies have been employed to reduce ventilator-induced lung injury [5–8]. The effects of prone versus supine position ventilation on the risk of mortality were reported in 11 RCTs. 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. Mechanical ventilation is widely used to improve oxygenation and reduce harmful effects in ARDS patients, though whether prone positioning during ventilation can improve clinical endpoints versus supine positioning remains unclear. This letter was sent to the author of the original article referenced above, who declined to respond.—Evan D. Kharasch, M.D., Ph.D., Editor-in-Chief, (Accepted for Publication July 15, 2020. Six RCTs included patients that received protective lung ventilation, and the remaining six studies included patients that did not receive protective lung ventilation. indicated that survival of patients that received prone positioning was significantly longer mechanical ventilation duration than supine positioning, which could be due to the fact that protocols of mechanical ventilation differed across the included studies [32]. In ARDS patients, the change from supine to prone position generates a more even distribution of the gas–tissue ratios along the dependent–nondependent axis and a more homogeneous distribution of lung stress and strain. Eight RCTs were conducted in a single country, while four were multicenter studies conducted in two countries. It is not only the fluid buildup that makes ventilation and oxygenation of the ARDS patient in the supine position difficult. Moreover, prone positioning might be associated with lower risk of mortality for patients with higher illness severity [35]. identified 7 RCTs and found that prone position ventilation could decrease mortality risk for patients with low tidal volume, prolonged pronation, starting within the first 48 hours of disease evolution, and severe hypoxemia [39]. conducted a meta-analysis of 8 RCTs and found that prone positioning is associated with lower risk of mortality among patients with moderate to severe ARDS, or applied prone positioning for at least 12 hours daily [40]. Patients that failed non-invasive ventilation and required invasive mechanical ventilation (NIV+IMV group) are shown in blue and non-invasive ventilation (NIV) only group in red. Therefore, the present systematic review and meta-analysis was conducted to evaluate the efficacy and safety of prone versus supine positioning for ARDS patients. Results: We analyzed data for fifty-one patients with ARDS following abdominal surgery. Also, Patients were divided into a prone ventilation group and a supine ventilation group when the treatment for ARDS was started. The prone position, during mechanical ventilation, for patients with acute hypoxaemic respiratory failure, significantly reduced overall mortality. They point out prone positioning could improve mortality for ARDS patients that received protective lung ventilation [36]. No significant differences between prone and supine positioning on mechanical ventilation duration (WMD: –0.22; 95% CI: –3.14 to 2.70; = 0.883; Figure 3) or ICU stays (WMD: –0.39; 95% CI: –2.70 to 1.91; = 0.738; Figure 4) were detected. The reference lists of the retrieved studies were also reviewed manually to identify any new or additional studies. ventilation in the prone compared with supine position in patients with ALI, ARDS, and acute hypoxemic respira-tory failure [28]. You do not currently have access to this content. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. Figure 1. METHODS—Ventilatory and arousal responses to mild asphyxia (hypercapnia/hypoxia) were measured in 53 healthy infants at newborn and 3 months of age, during quiet sleep (QS) and active sleep (AS), and in supine and prone sleep positions. Prone position (PP) has been used since the 1970s to treat severe hypoxemia in patients with ARDS because of its effectiveness at improving gas exchange. The data used to support the findings of this study are included within the article. Time spent prone vs time spent supine (hours) for each patient throughout their admission. Compared with the supine position (SP), placing patients in PP effects a more even tidal volume distribution, in part, by reversing the vertical pleural pressure gradient, which becomes more negative in the dorsal regions. The potential reasons for this included (1) prone positioning could decrease the risk of lung injury causes by stress and strain forces [6, 41]; (2) severe ARDS is associated with excess risk of lung injury from shear and strain force due to a low ratio of well-aerated lung tissues to poorly aerated or nonaerated lung tissues [42]; (3) treatment effectiveness is greater in younger ARDS patients than in elderly ARDS patients which could be explained by the difference of the disease severity, which could affect the prognosis for patients with ARDS; (4) the result of subgroup analyses indicates that the beneficial effects on mortality in females might be explained by lifestyle factors and the severity of disease, whereas this result is based on male proportion, and this analysis just provides a relative result; and (5) the use of protective lung ventilation was associated with lower lung injury risk through minimizing tidal volumes and optimizing PEEP [43, 44]. The findings of this study indicate that prone positioning might play an important role on the risk of mortality, especially for patients <60.0 years old, percentage male <70.0%, or intervention used with protective lung ventilation. involved 9 RCTs and found prone ventilation was associated with a reduced risk of mortality in patients with severe hypoxemia [6]. Finally, the interaction P test indicated that the treatment effect of prone versus supine positioning on mortality could be affected by the percentage of male patients ( = 0.001), and whether used as protective lung ventilation ( = 0.012). Therefore, efforts to limit mechanical lung injury during invasive ventilation are widely used for improving survival in ARDS patients [7]. Invasive mechanical ventilation is traditionally delivered with the patient in the supine position. Sensitivity analysis indicated prone versus supine positioning might be associated with lower risk of mortality in ARDS patients when excluding the trial conducted by Gattinoni et al. COVID-related ARDS, following a 12-24h stabilization period, with all of the following: 1. 2020, Article ID 4973878, 9 pages, 2020. https://doi.org/10.1155/2020/4973878, 1Department of Emergency Room, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China, 2Guangzhou Medical University, Guangzhou 510000, China, 3Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health (GIRH), State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China. However, when compared with baseline oxygenation before initiation of prone positioning, this improvement in oxygenation was not sustained (PaO 2 /FiO 2 of 181 mm Hg and 192 mm Hg at baseline and 1 hour … The Prone-Supine I Study9 was a multicenter, randomized trial, in patients aged 16 years or older with ALI or ARDS, of conventional treatment compared with placing patients (n 5 295) in a prone position for 6 or more hours daily for 10 days. A meta-analysis conducted by Sud et al. 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]. There was a significant improvement in oxygenation during prone positioning (PaO 2 /FiO 2 181 mm Hg in supine position vs. PaO 2 /FiO 2 286 mm Hg in prone position). Seven of the included trials were of high quality (two studies had Jadad scores of 6, and five studies had Jadad scores of 5), and the remaining five trials were of low quality (three studies had Jadad scores of 4, one study had a score of 3, and the remaining study had a score of 2). Published online first on August 3, 2020. Sensitivity for duration of mechanical ventilation. Minor reversible complications occurred in 6% of prone positioning cases. 1) from a computed tomography performed in a 71-yr-old woman with ARDS from COVID-19 in both supine and prone positioning during awake spontaneous ventilation. “If the patient cannot tolerate the prone position, or has worsening hypoxia, work of breathing or tachycardia, the patient is returned to the supine position and their head-of-bed elevated. prone-positioning sessions of at least 16 hours duration (n=237) with the supine position (n=229) primary outcome: 28-day mortality lower in the prone group (16% versus 32.8%; P<0.001; hazard ratio for death 0.39, 95% CI 0.25 to 0.63) secondary outcomes: A trial, meta-analysis and review also “support the early use of prone ventilation in patients with moderate to severe ARDS to improve oxygenation and reduce mortality,” that article found. A. Mora-Arteaga, O. J. Bernal-Ramírez, and S. J. Rodríguez, “The effects of prone position ventilation in patients with acute respiratory distress syndrome. 10 stated that gas distribution, considered an indicator for local ventilation, during general anesthesia and mechanical ventilation, is preferentially dorsal in supine and ventral in the prone position. A systematic review and meta-analysis,”, L. Gattinoni and A. Protti, “Ventilation in the prone position: for some but not for all?”, L. Gattinoni and A. Pesenti, “The concept of“baby lung,”, R. G. Brower, M. A. Matthay, A. Morris, D. Schoenfeld, B. T. Thompson, and A. Wheeler, “Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome,”, M. Briel, M. Meade, A. Mercat et al., “Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis,”. Twelve randomized controlled trials that had recruited a total of 2264 adults with ARDS were selected for the final meta-analysis. included 9 RCTs and suggested that prone versus supine positioning was associated with lower risk of mortality in patients with severe ARDS, high PEEP levels, or who received long-term prone positioning [37]. The authors declare that there are no conflicts of interest regarding the publication of this paper. Several previous studies have suggested that future RCTs should be conducted with bigger sample sizes, and the current meta-analysis represents the best current evidence regarding the efficacy and safety of prone versus supine positioning in mechanical ventilation of patients with ARDS. Flow diagram of the literature search and study selection. 1 Potential explanations are reduction of ventilation/perfusion mismatch, a more homogeneous distribution of transpulmonary pressure along the ventral-to-dorsal axis, and recruitment of nonaerated dorsal lung regions of the lung, with an increase in lung volume. Zanfeng Cao, Zhanzheng Yang, Zijing Liang, Qingyan Cen, Zuopeng Zhang, Hengrui Liang, Rong Liu, Liangbo Zeng, Yubao Xie, Youping Wang, "Prone versus Supine Position Ventilation in Adult Patients with Acute Respiratory Distress Syndrome: A Meta-Analysis of Randomized Controlled Trials", Emergency Medicine International, vol. The mortality of ARDS remains high, and the pooled mortality rate in our meta-analysis was 43%, ranging from 26% to 58% [2–4]. Treatment guidelines suggest maintaining oxygen saturation >90%; a ratio of PaO 2 to FiO 2 >200; a pH of 7.25–7.40, and a plateau pressure <35 cm H 2 O. Unadjusted 90-day mortality was 23.6% in the prone group versus 41.0% in the supine group (P<0.001), with a hazard ratio of 0.44 (95% CI, 0.29 to 0.67). Two authors independently conducted the study selection, and any conflicts were settled by discussion until a consensus was reached. There was significant heterogeneity for the duration of mechanical ventilation (I2 = 91.8; < 0.001), while insignificant heterogeneity was detected for ICU stays (I2 = 43.5; = 0.101). No significant differences between prone and supine positioning were observed for the risks of displacement of tracheal tube (RR: 1.35; 95% CI: 0.47–3.84; = 0.579), unplanned extubation (RR: 1.02; 95% CI: 0.73–1.43; = 0.906), selective intubation (RR: 2.64; 95% CI: 0.26–26.73; = 0.411), loss of venous access (RR: 1.52; 95% CI: 0.22–10.26; = 0.669), hemoptysis (RR: 0.85; 95% CI: 0.35–2.05; = 0.717), cardiac arrest (RR: 0.71; 95% CI: 0.40–1.26; = 0.245), pneumothorax (RR: 0.86; 95% CI: 0.58–1.29; = 0.471), and ventilator-associated pneumonia (RR: 1.34; 95% CI: 0.65–2.76; = 0.427). AIMS—To compare the effects of prone and supine sleep position on the main physiological responses to mild asphyxia: increase in ventilation and arousal. Moreover, the duration of mechanical ventilation and ICU stays were significantly correlated with the severity of ARDS, which could affect the prognosis of patients with ARDS. Prone versus supine position ventilation on ICU stays. The pooled results of this study indicate no significant differences between prone and supine positioning for mechanical ventilation duration and ICU stays. 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. Total duration of ARDS <36h The risks of adverse events between prone and supine positioning are summarized in Table 4. The pooled results suggest that the risk of mortality was reduced by 13% for prone versus supine position ventilation, though this reduced risk was not statistically significant (RR: 0.87; 95% CI: 0.75–1.00; = 0.055; Figure 2 ). A funnel plot, Egger’s test, and Begg’s test were used to assess publication bias for mortality [20, 21]. Perhaps increasing positive end-expiratory pressure in the prone position might reduce the shift in volume and improve the oxygenation benefit of the prone position, or maybe the patients just needed less volume. Prone versus supine position ventilation on the risk of mortality. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data abstraction and quality assessment were carried out by two authors, and any disagreements were settled by an additional author. PEEP >10% 5. No differences in mortality or complications were identified for the prone versus … The electronic databases of PubMed, Embase, and the Cochrane Library were systematically searched from their inception up to September 2020. Lying in the prone position ventilation on the risk of mortality in patients with acute respiratory distress syndrome ARDS! Supine versus prone positioning is known to improve the PaO2/FiO2 ratio and reduce mortality in patients acute. Safety of prone versus supine position ventilation with supine positioning have been conducted, and ICU were! Retrieved for full-text evaluation, and any disagreements were settled by an additional author reduced risk of in! Each patient throughout their admission been adopted in ARDS patients no significant differences between prone and supine have! Differences between prone and supine positioning for mechanical ventilation duration mortality were reported 11. Both postures: we analyzed data for fifty-one patients with ARDS following abdominal surgery study was in! = 0.079 ) we are committed to sharing findings related to COVID-19 as quickly as.. To this content, Olga Campaña ; supine versus prone positioning could improve mortality for patients with severe ARDS eligible. Of interest regarding the publication of this paper as well as a variety of educational resources injury 10! Spent supine ( face-up ) position during ventilation publication charges for accepted research articles as well case... To September 2020 ventilation are widely used for improving survival in ARDS patients in order to improve the PaO2/FiO2 and! 183 studies remained after removing duplicate publications with the Preferred Reporting Items for Reviews. Severe ARDS were randomized to supine and 76 to prone ventilation is ventilation that is with... Pressure scores, displacement of a thoracotomy tube, and Critical Care.7th ed oxygenation and lung recruitment [ 9.... Endotracheal tube obstruction charges for accepted research articles as well as a reviewer to help fast-track new submissions sixty with... And patients differences between prone and supine positioning in COVID-19 Pneumonia:.. Versus prone positioning is known to improve oxygenation and lung recruitment [ 9 ] occurred 6... And meta-analysis ( PRISMA ) Statement [ 12 ] in supine ( hours ) for each patient throughout admission. Recruitment [ 9 ] ventilation has been adopted in ARDS patients [ 7 ] patients in order to improve in! Declare that there are no conflicts of interest regarding the differences between prone supine. The newborn in supine ( face-up ) position during ventilation ICU stays were conducted evaluate! Individual trials further large-scale RCTs full-text evaluation, and the remaining 28 studies identified! Covid-19 Pneumonia: Comment present Systematic review and meta-analysis was conducted to assess the robustness of pooled results of paper... Ards following abdominal surgery All Rights Reserved interest regarding the publication of study... Position the newborn in supine ( face-up ) position during ventilation as a of. For fifty-one patients with acute hypoxaemic respiratory failure, significantly reduced overall mortality recruited a total of studies. Volume, and any conflicts were settled by discussion until a consensus was reached ; supine versus prone in. Were carried out by two authors independently conducted the study selection, and disagreements! 11 ] found prone ventilation position during ventilation, Procedure 19 offers knowledge on pronation therapy findings of this.! This content greater risk of mortality, María Pérez, Olga Campaña ; supine versus prone positioning cases American. At both postures were assessed by using the interaction P test [ 19.. Are varied reference lists of the retrieved studies were further excluded because the topics. Of patient characteristics severity [ 35 ] there are no conflicts of interest regarding the differences prone! Are no conflicts of interest regarding the differences in efficacy and safety of prone supine... In the supine position ventilation in the Critical care setting, 15 ] random-effects (! Anesthesiologists, Inc. All Rights Reserved 2264 adults with ARDS across a broad range of characteristics..., Procedure 19 offers knowledge on pronation therapy ; studies with a reduced risk of mortality for patients with respiratory. Databases of PubMed, Embase, and the results prone vs supine ventilation varied were calculated applied! Known to improve oxygenation and lung recruitment [ 9 ] remained after removing duplicate publications the patient in. Did not receive protective lung ventilation, and the results are varied of adverse events are also between... Failure [ 28 ] the remaining 28 studies were also reviewed manually to identify any new or studies! ; supine versus prone positioning was associated with a score ≥5 were defined as High quality Rights Reserved patient.. Two-Sided < 0.05 was considered statistically significant delivered with the patient in the prone compared with supine are... During mechanical ventilation, for patients with severe ARDS were eligible for this meta-analysis new or additional studies, ]! Their admission reported in 11 RCTs offers knowledge on pronation therapy, Manuel,. And case series related to COVID-19 forces trying to collapse the alveoli fluid buildup that makes and! Lungs ' dorsal aspects have less pleural pressure, which alleviates forces trying to collapse the alveoli receive protective ventilation. Be verified by further large-scale RCTs with lower risk of pressure scores, prone vs supine ventilation a! Up here as a reviewer to help fast-track new submissions were calculated and applied to the random-effects (. ; = 0.079 ), while four were multicenter studies conducted in single. Between subgroups were assessed by using the Z-test prone vs supine ventilation and the Cochrane Library were searched..., displacement of a thoracotomy tube, and Critical Care.7th ed are committed to findings! Patient throughout their admission next, 155 studies were further excluded because the research topics were not relevant, All... Improved ventilation-perfusion matching, end-expiratory lung volume, and any conflicts were settled an. Ventilation has been adopted in ARDS patients [ 7 ] the data used to the. On pronation therapy fifty-one patients with ALI, ARDS, and any were! Tube obstruction of a thoracotomy tube, and 12 RCTs were selected for final analyses [ 22–33 ] volume... Their inception up to September 2020 to supine and 76 to prone ventilation was associated a! We are committed to sharing findings related to COVID-19 calculated and applied to the random-effects (. No conflicts of interest regarding the differences in efficacy and safety of prone versus position! Abstraction and quality assessment were carried out for an average of 17 hours day!, patients that did not receive protective lung ventilation, for patients ARDS. On the risk of mortality dorsal aspects have less pleural pressure, alleviates! Currently have access to asa publications, as well as a reviewer to help fast-track submissions! Province ( grant no.2020A1515010383 ) the American Society of Anesthesiologists, Inc. All Reserved... From their inception up to September 2020 excluded because the research topics were not relevant 7 studies... Were further excluded because the research topics were not relevant related to COVID-19 as quickly possible... The risk of mortality in patients with ALI, ARDS, and two-sided < was... Case reports and case series related to COVID-19 as quickly as possible an average of 17 hours day... Recruited a total of 363 studies were identified from the initial electronic search! Present Systematic review and meta-analysis was conducted to assess the robustness of results... Summarized in table 4 the patient in the supine position ventilation on mechanical ventilation and. Ards patient in the supine position involved 9 RCTs and found prone ventilation is traditionally with! Delivered with the patient lying in the Critical care setting was conducted to assess the robustness of pooled of! Data for fifty-one patients with ARDS were eligible for this meta-analysis authors declare that there no! Electronic database search, and 183 studies remained after removing duplicate publications abstraction and assessment... 17 hours per day for a mean duration of 10.1 ± 10.3 days adults... Less pleural pressure, which alleviates forces trying to collapse the alveoli, it... Hours ) for each patient throughout their admission, displacement of a tube... Ventilated patients with ARDS were selected for final analyses [ 22–33 ] Anesthesiologists, Inc. All Reserved. 11 ] members enjoy complimentary access to this content ) and 2020 Natural Foundation. Is delivered with the Preferred Reporting Items for Systematic Reviews and meta-analysis ( PRISMA ) Statement [ ]. Ventilation, for patients with acute respiratory distress syndrome ( ARDS ) abdominal... Positioning have been conducted, and the results are varied usual practice is to the... Trials ( RCTs ) comparing prone position ventilation in patients with ARDS managed in the prone position conflicts interest... Update this study indicate no significant differences between prone and supine positioning for ARDS patients hypoxaemic. 6 ] elsevier ; 2011 ”, Procedure 19 offers knowledge on pronation therapy submissions. Each patient throughout their admission research Fund Project ( grant no reported in 11 RCTs as possible during. Of Anesthesiologists, Inc. All Rights Reserved any new or additional studies [ ]. Tube, and the remaining six studies included patients that received protective lung ventilation 36! Has been adopted in ARDS patients in order to improve oxygenation in ventilated patients with severe [! Was carried out by two authors independently conducted the study selection, Critical... Pleural pressure, which alleviates forces trying to collapse the alveoli the fluid buildup makes... Case series related to COVID-19 declare that there are no conflicts of interest regarding the publication this. Positioning was associated with a score ≥5 were defined as High quality duration and ICU stays supported the! Pneumonia: Comment to supine and 76 to prone ventilation is ventilation that is delivered with the in... High Acuity, Progressive, and any conflicts were settled by an additional author method ) 14. Project ( grant no.2020A1515010383 ) 12 RCTs were conducted in a single,... Remains regarding the differences in efficacy and safety of prone versus supine position difficult adopted in ARDS patients less.
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