In the supine group, measurements were performed every 6 hours; in the prone group, measurements were performed just before the patient was turned to the prone position, after 1 … 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). Sign up here as a reviewer to help fast-track new submissions. 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,”. 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). 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). By continuing to use our website, you are agreeing to, A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology, https://doi.org/10.1097/ALN.0000000000003511, Intubation and Ventilation amid the COVID-19 Outbreak, Calculating Ideal Body Weight: Keep It Simple, Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018, The Effect of Prone Positioning on Intraocular Pressure in Anesthetized Patients, Emergence from Anesthesia in the Prone versus   Supine Position in Patients Undergoing Lumbar Surgery, Effects of Prone Positioning on Transpulmonary Pressures and End-expiratory Volumes in Patients without Lung Disease, Positional Therapy and Regional Pulmonary Ventilation: High-resolution Alignment of Prone and Supine Computed Tomography Images in a Large Animal Model, Lung Ventilation and Perfusion in Prone and Supine Postures with Reference to Anesthetized and Mechanically Ventilated Healthy Volunteers, © Copyright 2021 American Society of Anesthesiologists. TV <=6cc/kg PBW 3. 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). Twelve randomized controlled trials that had recruited a total of 2264 adults with ARDS were selected for the final meta-analysis. A concurrent study reported that pas-sive mechanical ventilation in the supine position (SP) Arterial blood gas analysis in the supine position with high-flow nasal cannula oxygen therapy (50% concentration; flow rate, 50 l/min) showed Pao2/fractional inspired oxygen tension (Fio2) of 130, with an improvement in... Search for other works by this author on: Clinical University Hospital of Santiago, Spain, and Sanitary Research Institute of Santiago (FIDIS), Santiago de Compostela, Spain (M.T.). ventilation in the prone compared with supine position in patients with ALI, ARDS, and acute hypoxemic respira-tory failure [28]. Data abstraction and quality assessment were carried out by two authors, and any disagreements were settled by an additional author. 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 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. All the pooled effects were determined using the Z-test, and two-sided  < 0.05 was considered statistically significant. Figure 1. Flow diagram of the literature search and study selection. 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. Minor reversible complications occurred in 6% of prone positioning cases. FiO2 >60% 4. The authors declare that there are no conflicts of interest regarding the publication of this paper. Munshi et al. Prone versus supine position ventilation on the risk of mortality. These conclusions are not stable and could be altered by excluding individual trials. ARDS patients that received prone position ventilation could experience increased risk of pressure scores, displacement of a thoracotomy tube, and endotracheal tube obstruction. Moreover, patients that received prone positioning could had increased risk of pressure ulcers and major airway problems [38]. The adverse events are also summarized between prone and supine positioning for ARDS 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. PEEP >10% 5. The prone position, during mechanical ventilation, for patients with acute hypoxaemic respiratory failure, significantly reduced overall mortality. Furthermore, the heterogeneity across included trials for mechanical ventilation duration, which could be explained by various characteristics and disease status for included patients. Thus, a prone-to-supine change would be the opposite of what Lemaire and colleagues observed when removing positive pressure . It is not only the fluid buildup that makes ventilation and oxygenation of the ARDS patient in the supine position difficult. 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. In 2014, they update this study and contained 11 RCTs. The numbers of studies available for mechanical ventilation duration and ICU stays were six (7 cohorts) and six (7 cohorts), respectively. A study by Hu et al. Prone ventilation is ventilation that is delivered with the patient lying in the prone position. Moreover, there were no significant differences between prone and supine positioning for mechanical ventilation duration and ICU stays. Our findings indicate that ARDS patients that underwent ventilation with prone positioning might experience lower risk of mortality, shorter mechanical ventilation duration, and longer ICU stays, although the pooled effect estimates suggest no significant differences between groups. 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]. The data used to support the findings of this study are included within the article. [25] (Table 2). RCTs investigating the efficacy and safety of prone versus supine position ventilation in patients with ARDS were eligible for this meta-analysis. 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). Therefore, it is incorporated into regular clinical practice of managing patients with ARDS in critical care and … 183 studies remained after removing duplicate publications the Critical care setting table.. 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