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The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials

  
@article{JTD3737,
	author = {So Young Park and Hyun Jung Kim and Kwan Ha Yoo and Yong Bum Park and Seo Woo Kim and Seok Jeong Lee and Eun Kyung Kim and Jung Hyun Kim and Yee Hyung Kim and Ji-yong Moon and Kyung Hoon Min and Sung Soo Park and Jinwoo Lee and Chang-Hoon Lee and Jinkyeong Park and Min Kwang Byun and Sei Won Lee and ChinKook Rlee and Ji Ye Jung and Yun Su Sim},
	title = {The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials},
	journal = {Journal of Thoracic Disease},
	volume = {7},
	number = {3},
	year = {2015},
	keywords = {},
	abstract = {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.},
	issn = {2077-6624},	url = {http://jtd.amegroups.com/article/view/3737}
}