TY - JOUR
T1 - The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome
T2 - A meta-analysis of randomized controlled trials
AU - Park, So Young
AU - Kim, Hyun Jung
AU - Yoo, Kwan Ha
AU - Park, Yong Bum
AU - Kim, Seo Woo
AU - Lee, Seok Jeong
AU - Kim, Eun Kyung
AU - Kim, Jung Hyun
AU - Kim, Yee Hyung
AU - Moon, Ji yong
AU - Min, Kyung Hoon
AU - Park, Sung Soo
AU - Lee, Jinwoo
AU - Lee, Chang Hoon
AU - Park, Jinkyeong
AU - Byun, Min Kwang
AU - Lee, Sei Won
AU - Rlee, Chin Kook
AU - Jung, Ji Ye
AU - Sim, Yun Su
PY - 2015
Y1 - 2015
N2 - Background: Prone positioning for acute respiratory distress syndrome (ARDS) has no impact on mortality despite significant improvements in oxygenation. However, a recent trial demonstrated reduced mortality rates in the prone position for severe ARDS. We evaluated effects of prone position duration and protective lung strategies on mortality rates in ARDS. Methods: We extensively searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) reporting on prone positioning during acute respiratory failure in adults for inclusion in our meta-analysis. Results: Eight trials met our inclusion criteria, Totals of 1,099 and 1,042 patients were randomized to the prone and supine ventilation positions. The mortality rates associated with the prone and supine positions were 41% and 47% [risk ratio (RR), 0.90; 95% confidence interval (CI), 0.82-0.98, P=0.02], but the heterogeneity was moderate (P=0.01, I2=61%). In a subgroup analysis, the mortality rates for lung protective ventilation (RR 0.73, 95% CI, 0.62-0.86, P=0.0002) and duration of prone positioning >12 h (RR 0.75, 95% CI, 0.65-0.87, P<0.0001) were reduced in the prone position. Prone positioning was not associated with an increased incidence of cardiac events (RR 1.01, 95% CI, 0.87-1.17) or ventilator associated pneumonia (RR 0.88, 95% CI, 0.71-1.09), but it was associated with an increased incidence of pressure sores (RR 1.23, 95% CI, 1.07-1.41) and endotracheal dislocation (RR 1.33, 95% CI, 1.02-1.74). Conclusions: Prone positioning tends to reduce the mortality rates in ARDS patients, especially when used in conjunction with a lung protective strategy and longer prone position durations. Prone positioning for ARDS patients should be prioritized over other invasive procedures because related life-threatening complications are rare. However, further additional randomized controlled design to study are required for confirm benefit of prone position in ARDS.
AB - Background: Prone positioning for acute respiratory distress syndrome (ARDS) has no impact on mortality despite significant improvements in oxygenation. However, a recent trial demonstrated reduced mortality rates in the prone position for severe ARDS. We evaluated effects of prone position duration and protective lung strategies on mortality rates in ARDS. Methods: We extensively searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) reporting on prone positioning during acute respiratory failure in adults for inclusion in our meta-analysis. Results: Eight trials met our inclusion criteria, Totals of 1,099 and 1,042 patients were randomized to the prone and supine ventilation positions. The mortality rates associated with the prone and supine positions were 41% and 47% [risk ratio (RR), 0.90; 95% confidence interval (CI), 0.82-0.98, P=0.02], but the heterogeneity was moderate (P=0.01, I2=61%). In a subgroup analysis, the mortality rates for lung protective ventilation (RR 0.73, 95% CI, 0.62-0.86, P=0.0002) and duration of prone positioning >12 h (RR 0.75, 95% CI, 0.65-0.87, P<0.0001) were reduced in the prone position. Prone positioning was not associated with an increased incidence of cardiac events (RR 1.01, 95% CI, 0.87-1.17) or ventilator associated pneumonia (RR 0.88, 95% CI, 0.71-1.09), but it was associated with an increased incidence of pressure sores (RR 1.23, 95% CI, 1.07-1.41) and endotracheal dislocation (RR 1.33, 95% CI, 1.02-1.74). Conclusions: Prone positioning tends to reduce the mortality rates in ARDS patients, especially when used in conjunction with a lung protective strategy and longer prone position durations. Prone positioning for ARDS patients should be prioritized over other invasive procedures because related life-threatening complications are rare. However, further additional randomized controlled design to study are required for confirm benefit of prone position in ARDS.
KW - Acute respiratory distress syndrome (ARDS)
KW - Mortality
KW - Prone positioning
UR - http://www.scopus.com/inward/record.url?scp=84928600792&partnerID=8YFLogxK
U2 - 10.3978/j.issn.2072-1439.2014.12.49
DO - 10.3978/j.issn.2072-1439.2014.12.49
M3 - Article
AN - SCOPUS:84928600792
SN - 2072-1439
VL - 7
SP - 356
EP - 367
JO - Journal of Thoracic Disease
JF - Journal of Thoracic Disease
IS - 3
ER -