The effect of prone positioning in acute respiratory distress syndrome or acute lung injury: a meta-analysis. Areas of uncertainty and recommendations for research

Objective To compare the effects of ventilation in prone and in supine position in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Design Meta-analysis of randomised controlled trials. Data sources BioMedCentral, PubMed, CINAHL, and Embase (to November 2007), with add...

Full description

Saved in:
Bibliographic Details
Published in:Intensive care medicine 2008-06, Vol.34 (6), p.1002-1011, Article 1002
Main Authors: Abroug, Fekri, Ouanes-Besbes, Lamia, Elatrous, Souheil, Brochard, Laurent
Format: Article
Language:English
Subjects:
Acute Lung Injury - mortality
Acute Lung Injury - physiopathology
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthesiology
Biological and medical sciences
Critical Care Medicine
Data Interpretation, Statistical
Emergency and intensive respiratory care
Emergency Medicine
Humans
Intensive
Intensive care
Intensive care medicine
Intensive Care Units
Medical sciences
Medicine
Medicine & Public Health
Meta-analysis
Mortality
Pain Medicine
Patient positioning
Pediatrics
Pneumology/Respiratory System
Pneumonia
Prone Position - physiology
Randomized Controlled Trials as Topic
Respiration, Artificial - methods
Respiratory distress syndrome
Respiratory Distress Syndrome, Adult - mortality
Respiratory Distress Syndrome, Adult - physiopathology
Respiratory failure
Systematic Review
Ventilators
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objective To compare the effects of ventilation in prone and in supine position in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Design Meta-analysis of randomised controlled trials. Data sources BioMedCentral, PubMed, CINAHL, and Embase (to November 2007), with additional information from authors. Measurements and results From selected randomised controlled trials comparing positioning in ALI/ARDS we extracted data concerning study design, disease severity, clinical outcomes, and adverse events. Five trials including 1,372 patients met the inclusion criteria for mortality analysis; one trial was added to assess the effects on acquisition of ventilator-associated pneumonia (VAP). The included trials were significantly underpowered and enrolled patients with varying severity. Prone positioning duration and mechanical ventilation strategy were not standardised across studies. Using a fixed-effects model, we did not find a significant effect of prone positioning (proning) on mortality (odds ratio 0.97, 95% confidence interval 0.77–1.22). The PaO 2 /FiO 2 ratio increased significantly more with proning (weighted means difference 25 mmHg, p  
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-008-1062-3