RT Journal Article
SR Electronic
T1 Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E381
OP E390
DO 10.1503/cmaj.140081
VO 186
IS 10
A1 Sachin Sud
A1 Jan O. Friedrich
A1 Neill K. J. Adhikari
A1 Paolo Taccone
A1 Jordi Mancebo
A1 Federico Polli
A1 Roberto Latini
A1 Antonio Pesenti
A1 Martha A.Q. Curley
A1 Rafael Fernandez
A1 Ming-Cheng Chan
A1 Pascal Beuret
A1 Gregor Voggenreiter
A1 Maneesh Sud
A1 Gianni Tognoni
A1 Luciano Gattinoni
A1 Claude Guérin
YR 2014
UL http://www.cmaj.ca/content/186/10/E381.abstract
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.