PT  - JOURNAL ARTICLE
AU  - Sachin Sud
AU  - Jan O. Friedrich
AU  - Neill K. J. Adhikari
AU  - Paolo Taccone
AU  - Jordi Mancebo
AU  - Federico Polli
AU  - Roberto Latini
AU  - Antonio Pesenti
AU  - Martha A.Q. Curley
AU  - Rafael Fernandez
AU  - Ming-Cheng Chan
AU  - Pascal Beuret
AU  - Gregor Voggenreiter
AU  - Maneesh Sud
AU  - Gianni Tognoni
AU  - Luciano Gattinoni
AU  - Claude Guérin
TI  - Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis
AID  - 10.1503/cmaj.140081
DP  - 2014 Jul 08
TA  - Canadian Medical Association Journal
PG  - E381--E390
VI  - 186
IP  - 10
4099  - http://www.cmaj.ca/content/186/10/E381.short
4100  - http://www.cmaj.ca/content/186/10/E381.full
SO  - CMAJ2014 Jul 08; 186
AB  - Background: Mechanical ventilation in the prone position is used to improve oxygenation and to mitigate the harmful effects of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). We sought to determine the effect of prone positioning on mortality among patients with ARDS receiving protective lung ventilation.Methods: We searched electronic databases and conference proceedings to identify relevant randomized controlled trials (RCTs) published through August 2013. We included RCTs that compared prone and supine positioning during mechanical ventilation in patients with ARDS. We assessed risk of bias and obtained data on all-cause mortality (determined at hospital discharge or, if unavailable, after longest follow-up period). We used random-effects models for the pooled analyses.Results: We identified 11 RCTs (n = 2341) that met our inclusion criteria. In the 6 trials (n = 1016) that used a protective ventilation strategy with reduced tidal volumes, prone positioning significantly reduced mortality (risk ratio 0.74, 95% confidence interval 0.59–0.95; I2 = 29%) compared with supine positioning. The mortality benefit remained in several sensitivity analyses. The overall quality of evidence was high. The risk of bias was low in all of the trials except one, which was small. Statistical heterogeneity was low (I2 < 50%) for most of the clinical and physiologic outcomes.Interpretation: Our analysis of high-quality evidence showed that use of the prone position during mechanical ventilation improved survival among patients with ARDS who received protective lung ventilation.