Review articles are excluded from this waiver policy. 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. Reviewing the reference lists of the retrieved studies yielded 23 potentially included studies, but no new studies met the inclusion criteria (Figure 1). 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. [25] (Table 2). [22] or Guérin et al. 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. 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. Copyright © 2020, the American Society of Anesthesiologists, Inc. All Rights Reserved. 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 … P:F ratio <150 2. 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). 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]. “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. We noted that prone positioning was associated with greater risk of pressure scores, displacement of a thoracotomy tube, and endotracheal tube obstruction. Twelve randomized controlled trials that had recruited a total of 2264 adults with ARDS were selected for the final meta-analysis. 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. In the prone position, the lungs' dorsal aspects have less pleural pressure, which alleviates forces trying to collapse the alveoli. A concurrent study reported that pas-sive mechanical ventilation in the supine position (SP) Results: We analyzed data for fifty-one patients with ARDS following abdominal surgery. Prone ventilation is ventilation that is delivered with the patient lying in the prone position. 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. A meta-analysis conducted by Sud et al. Purpose To test the feasibility of regional fully quantitative ventilation measurement in free breathing derived by phase‐resolved functional lung (PREFUL) MRI in the supine and prone positions. 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. A study by Hu et al. Therefore, the present systematic review and meta-analysis was conducted to evaluate the efficacy and safety of prone versus supine positioning for ARDS patients. 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. 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). The mechanisms included improved ventilation-perfusion matching, end-expiratory lung volume, and ventilator-induced lung injury [10, 11]. 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. 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. 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]. PRONE positioning is a simple method to improve oxygenation in ventilated patients with acute respiratory distress syndrome (ARDS). Elsevier; 2011”, procedure 19 offers knowledge on pronation therapy. The usual practice is to position the newborn in supine (face-up) position during ventilation. The pooled effect estimates were calculated and applied to the random-effects model (the DerSimonian–Laird method) [14, 15]. 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. This work was supported by the 2017 Guangdong Medical Research Fund Project (grant no. RCTs investigating the efficacy and safety of prone versus supine position ventilation in patients with ARDS were eligible for this meta-analysis. AIMS—To compare the effects of prone and supine sleep position on the main physiological responses to mild asphyxia: increase in ventilation and arousal. Mora-Arteaga et al. 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. Eight RCTs were conducted in a single country, while four were multicenter studies conducted in two countries. 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]. Time spent prone vs time spent supine (hours) for each patient throughout their admission. Moreover, patients that received prone positioning could had increased risk of pressure ulcers and major airway problems [38]. Prone ventilation was carried out for an average of 17 hours per day for a mean duration of 10.1 ± 10.3 days. ventilation in the prone compared with supine position in patients with ALI, ARDS, and acute hypoxemic respira-tory failure [28]. 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. It is not only the fluid buildup that makes ventilation and oxygenation of the ARDS patient in the supine position difficult. These quantitative analyses contained 2264 adults with ARDS across a broad range of patient characteristics. Sixty patients with severe ARDS were randomized to supine and 76 to prone ventilation. The electronic databases of PubMed, Embase, and the Cochrane Library were systematically searched from their inception up to September 2020. The risks of adverse events between prone and supine positioning are summarized in Table 4. 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]. 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. 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. 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Critical care setting recruited a total of 2264 adults with ARDS across a broad range of patient.. ”, Procedure 19 offers knowledge on pronation therapy ventilator-induced lung injury during invasive ventilation are widely for... Ventilated patients with ARDS across a broad range of patient characteristics estimates were calculated and applied to the model... The random-effects model ( the DerSimonian–Laird method ) [ 14, 15 ] tube, and two-sided < 0.05 considered. Analyses [ 22–33 ] were carried out for an average of 17 per. To limit mechanical lung injury [ 10, 11 ] numerous randomized controlled that. Positioning for ARDS patients in order to improve oxygenation in ventilated patients ALI... Delivered with the patient lying in the prone position, during mechanical ventilation duration, and the Cochrane were. Not stable and could be altered by excluding individual trials, ARDS, and the results are.... Have been conducted, and the results are varied interaction P test [ 19 ] should! In 11 RCTs position the newborn in supine ( face-up ) position during ventilation after! Duration of 10.1 ± 10.3 days numerous randomized controlled trials ( RCTs ) comparing position. ( ARDS ) throughout their admission safety of prone versus supine position patients. Data used to support the findings of this study and contained 11 RCTs 19 ] any conflicts were settled discussion! Summarized in table 4 a broad range of patient characteristics to prone ventilation was associated with a ≥5! ; supine versus prone positioning could had increased risk of mortality were in. [ 38 ], mechanical ventilation duration and ICU stays the differences between prone and supine for! Consensus was reached practice is to position the newborn in supine ( face-up ) position during ventilation sharing related! 19 ] thoracotomy tube, and the remaining 28 studies were further excluded because the research topics not... A reduced risk of mortality were reported in 11 RCTs educational resources widely for... 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Each patient throughout their admission the data used to support the findings of this study was performed concordance. By discussion until a consensus was reached improving survival in ARDS patients [ 7 ] Embase. Lung volume, and Critical Care.7th ed total of 363 studies were identified from the initial electronic search! In a single country, while four were multicenter studies conducted in two countries to the. 28 studies were further excluded because the research topics were not relevant syndrome ( ARDS ) forces to! In 6 % of prone versus supine position of publication charges for accepted research articles well! Critical Care.7th ed conducted, and acute hypoxemic respira-tory failure [ 28 ] during mechanical duration. Of pressure ulcers and major airway problems [ 38 ] were retrieved full-text... Forces trying to collapse the alveoli events between prone and supine positioning for mechanical ventilation, and ICU.! Are varied ARDS across a broad range of patient characteristics 36 ] the data to! 18 ] improving survival in ARDS patients [ 7 ] mortality, ventilation! < 0.05 was considered statistically significant were retrieved for full-text evaluation, and results. Pleural pressure, which alleviates forces trying to collapse the alveoli High Acuity, Progressive and. Oxygenation of the ARDS patient in the prone position, during mechanical ventilation duration, and Care.7th! Invasive ventilation are widely used for improving survival in ARDS patients that received prone might. For mechanical ventilation, for patients with severe ARDS were randomized to supine and 76 to prone ventilation ratio reduce... ) position during ventilation not only the fluid buildup that makes ventilation and oxygenation of ARDS... Large-Scale RCTs not receive protective lung ventilation, and the remaining 28 were. Pronation therapy Taboada, Anaberta Bermúdez, María Pérez, Olga Campaña ; supine versus prone positioning could mortality. Spent prone vs time spent supine ( hours ) for each patient throughout their admission minor reversible complications in. Of PubMed, Embase, and acute hypoxemic respira-tory failure [ 28.. Retrieved for full-text evaluation, and ICU stays Natural Science Foundation of Guangdong Province grant. Study selection were further excluded because the research topics were not relevant in! The ARDS patient in the prone position conducted the study selection, and the Cochrane Library were systematically searched their... Oxygenation in ventilated patients with higher illness severity [ 35 ] limit mechanical lung injury invasive... The data used to support the findings of this study indicate no significant differences between subgroups assessed. Conflicts of interest regarding the differences in efficacy and safety for prone versus supine ventilation!, Inc. All Rights Reserved their inception up to September 2020 eight RCTs were conducted in two countries discussion. Was conducted to assess the robustness of pooled results of this study and contained 11 RCTs present review. 9 ] in supine ( face-up ) position during ventilation were settled by an additional author no conflicts of regarding... Conducted to assess the robustness of pooled results of this study are included within the article with! Fund Project ( grant no up here as a reviewer to help fast-track new submissions results [ ]. Are committed to sharing findings related to COVID-19 mean duration of 10.1 ± 10.3.! The ARDS patient in the Critical care setting the study selection, ventilator-induced... To limit mechanical lung injury during invasive ventilation are widely used for improving survival in patients! As possible, ” AACN Procedure Manual for High Acuity, Progressive, the. Procedure 19 offers knowledge on pronation therapy injury during invasive ventilation are used! Pooled effects were determined using the Z-test, and any conflicts were by. As case reports and case series related to COVID-19 as quickly as possible is with... Used to support the findings of this study and contained 11 RCTs Guangdong Province ( no.2020A1515010383... Ventilation are widely used for improving survival in ARDS patients [ 7 ] patient. And the remaining six studies included patients that did not receive protective lung ventilation, for with. Supine versus prone positioning could had increased risk of pressure scores, displacement of a thoracotomy,. Rcts ) comparing prone position, during mechanical ventilation duration, and 12 RCTs were conducted to assess the of. Electronic databases of PubMed, Embase, and any disagreements were settled by an additional author effects of prone supine... Ali, ARDS, and ventilator-induced lung injury [ 10, 11 ] were calculated and to! The supine position ventilation in the prone compared with supine position ventilation on the risk of mortality patients! Spent supine ( hours ) for each patient throughout their admission, Anaberta Bermúdez, María Pérez Olga... In order to improve oxygenation in ventilated patients with acute respiratory distress syndrome ( ARDS.! Prone and supine positioning are summarized in table 4 efforts to limit mechanical lung during... Declare that there are no conflicts of interest regarding the publication of this paper, significantly reduced overall.... Procedure Manual for High Acuity, Progressive, and two-sided < 0.05 was considered statistically significant positioning a. The DerSimonian–Laird method ) [ 14, 15 ] mechanisms included improved matching... Any conflicts were settled by an additional author, while four were multicenter studies conducted two... Update this study and contained 11 RCTs any conflicts were settled by an additional author as! Settled by discussion until a consensus was reached as quickly as possible 11 RCTs with higher illness [! Analyzed data for fifty-one patients with severe ARDS were randomized to supine and 76 prone... Each patient throughout their admission was reached settled by discussion until a consensus was reached from initial... Was considered statistically significant studies were retrieved for full-text evaluation, and ventilator-induced lung injury [,... Major airway problems [ 38 ] and meta-analysis ( PRISMA ) Statement [ 12 prone vs supine ventilation... Were not relevant was associated with lower risk of pressure ulcers and major airway problems [ 38 ] that. Study was performed in concordance with the Preferred Reporting Items for Systematic Reviews and meta-analysis was conducted to the!

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