J A Mora-Arteaga1, O J Bernal-Ramírez2, S J Rodríguez3. 1. Medicina Crítica y Cuidado Intensivo, Universidad del Rosario, Fundación Santa Fe de Bogotá-Hospital Universitario, Bogotá D.C., Colombia. Electronic address: javiandrem@yahoo.com. 2. Medicina Crítica y Cuidado Intensivo, Clínica Nueva-Hospital de Suba, Bogotá D.C., Colombia. 3. Medicina Crítica y Cuidado Intensivo, Clínica Nueva-Hospital Universitario la Samaritana, Bogotá D.C., Colombia.
Abstract
INTRODUCTION: Prone position ventilation has been shown to improve oxygenation and ventilatory mechanics in patients with acute respiratory distress syndrome. We evaluated whether prone ventilation reduces the risk of mortality in adult patients with acute respiratory distress syndrome versus supine ventilation. METHODOLOGY: A metaanalysis of randomized controlled trials comparing patients in supine versus prone position was performed. A search was conducted of the Pubmed, Embase, Cochrane Library, and LILACS databases. Mortality, hospital length of stay, days of mechanical ventilation and adverse effects were evaluated. RESULTS: Seven randomized controlled trials (2,119 patients) were included in the analysis. The prone position showed a nonsignificant tendency to reduce mortality (OR: 0.76; 95%CI: 0.54 to 1.06; P=.11, I(2) 63%). When stratified by subgroups, a significant decrease was seen in the risk of mortality in patients ventilated with low tidal volume (OR: 0.58; 95%CI: 0.38 to 0.87; P=.009, I(2) 33%), prolonged pronation (OR: 0.6; 95%CI: 0.43 to 0.83; p=.002, I(2) 27%), start within the first 48hours of disease evolution (OR 0.49; 95%CI 0.35 to 0.68; P=.0001, I(2) 0%) and severe hypoxemia (OR: 0.51: 95%CI: 0.36 to 1.25; P=.0001, I(2) 0%). Adverse effects associated with pronation were the development of pressure ulcers and endotracheal tube obstruction. CONCLUSIONS: Prone position ventilation is a safe strategy and reduces mortality in patients with severely impaired oxygenation. It should be started early, for prolonged periods, and should be associated to a protective ventilation strategy.
INTRODUCTION: Prone position ventilation has been shown to improve oxygenation and ventilatory mechanics in patients with acute respiratory distress syndrome. We evaluated whether prone ventilation reduces the risk of mortality in adult patients with acute respiratory distress syndrome versus supine ventilation. METHODOLOGY: A metaanalysis of randomized controlled trials comparing patients in supine versus prone position was performed. A search was conducted of the Pubmed, Embase, Cochrane Library, and LILACS databases. Mortality, hospital length of stay, days of mechanical ventilation and adverse effects were evaluated. RESULTS: Seven randomized controlled trials (2,119 patients) were included in the analysis. The prone position showed a nonsignificant tendency to reduce mortality (OR: 0.76; 95%CI: 0.54 to 1.06; P=.11, I(2) 63%). When stratified by subgroups, a significant decrease was seen in the risk of mortality in patients ventilated with low tidal volume (OR: 0.58; 95%CI: 0.38 to 0.87; P=.009, I(2) 33%), prolonged pronation (OR: 0.6; 95%CI: 0.43 to 0.83; p=.002, I(2) 27%), start within the first 48hours of disease evolution (OR 0.49; 95%CI 0.35 to 0.68; P=.0001, I(2) 0%) and severe hypoxemia (OR: 0.51: 95%CI: 0.36 to 1.25; P=.0001, I(2) 0%). Adverse effects associated with pronation were the development of pressure ulcers and endotracheal tube obstruction. CONCLUSIONS: Prone position ventilation is a safe strategy and reduces mortality in patients with severely impaired oxygenation. It should be started early, for prolonged periods, and should be associated to a protective ventilation strategy.
Authors: María Dolores Rodríguez-Huerta; Ana Díez-Fernández; María Jesús Rodríguez-Alonso; María Robles-González; María Martín-Rodríguez; Alberto González-García Journal: Nurs Crit Care Date: 2021-03-16 Impact factor: 2.897
Authors: Waleed Alhazzani; Morten Hylander Møller; Yaseen M Arabi; Mark Loeb; Michelle Ng Gong; Eddy Fan; Simon Oczkowski; Mitchell M Levy; Lennie Derde; Amy Dzierba; Bin Du; Michael Aboodi; Hannah Wunsch; Maurizio Cecconi; Younsuck Koh; Daniel S Chertow; Kathryn Maitland; Fayez Alshamsi; Emilie Belley-Cote; Massimiliano Greco; Matthew Laundy; Jill S Morgan; Jozef Kesecioglu; Allison McGeer; Leonard Mermel; Manoj J Mammen; Paul E Alexander; Amy Arrington; John E Centofanti; Giuseppe Citerio; Bandar Baw; Ziad A Memish; Naomi Hammond; Frederick G Hayden; Laura Evans; Andrew Rhodes Journal: Intensive Care Med Date: 2020-03-28 Impact factor: 17.440
Authors: Waleed Alhazzani; Morten Hylander Møller; Yaseen M Arabi; Mark Loeb; Michelle Ng Gong; Eddy Fan; Simon Oczkowski; Mitchell M Levy; Lennie Derde; Amy Dzierba; Bin Du; Michael Aboodi; Hannah Wunsch; Maurizio Cecconi; Younsuck Koh; Daniel S Chertow; Kathryn Maitland; Fayez Alshamsi; Emilie Belley-Cote; Massimiliano Greco; Matthew Laundy; Jill S Morgan; Jozef Kesecioglu; Allison McGeer; Leonard Mermel; Manoj J Mammen; Paul E Alexander; Amy Arrington; John E Centofanti; Giuseppe Citerio; Bandar Baw; Ziad A Memish; Naomi Hammond; Frederick G Hayden; Laura Evans; Andrew Rhodes Journal: Crit Care Med Date: 2020-06 Impact factor: 7.598
Authors: Syeda Kashfi Qadri; Priscilla Ng; Theresa Shu Wen Toh; Sin Wee Loh; Herng Lee Tan; Cheryl Bin Lin; Eddy Fan; Jan Hau Lee Journal: Pulm Ther Date: 2020-10-21