The Efficacy and Safety of Prone Positional Ventilation in Acute Respiratory Distress Syndrome: Updated Study-Level Meta-Analysis of 11 Randomized Controlled Trials
OBJECTIVE:The survival benefit of prone positioning during mechanical ventilation for acute respiratory distress syndrome has been a matter of debate. Recent multicenter randomized controlled trials have shown a significant reduction of 28-day and 90-day mortality associated with prone positioning d...
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Veröffentlicht in: | Critical care medicine 2014-05, Vol.42 (5), p.1252-1262 |
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description | OBJECTIVE:The survival benefit of prone positioning during mechanical ventilation for acute respiratory distress syndrome has been a matter of debate. Recent multicenter randomized controlled trials have shown a significant reduction of 28-day and 90-day mortality associated with prone positioning during mechanical ventilation for severe acute respiratory distress syndrome. We performed an up-to-date meta-analysis on this topic and elucidated the effect of prone positioning on overall mortality and associated complications.
DATA SOURCES:PubMed, EMBASE, BioMed Central, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and conference proceedings through May 2013.
STUDY SELECTION:Randomized controlled trial comparing overall mortality of prone-versus-supine positioning in patients with acute respiratory distress syndrome.
DATA EXTRACTION:Data were extracted for populations, interventions, outcomes, and risk of bias. The prespecified primary endpoint was overall mortality, using the longest available follow-up in each study. The odds ratio with 95% CI was the effect measure.
DATA SYNTHESIS:This analysis included 11 randomized controlled trial, 2,246 total adult patients, and 1,142 patients ventilated in the prone position. Prone positioning during ventilation significantly reduced overall mortality in the random-effect model (odds ratio, 0.77; 95% CI, 0.59–0.99; p = 0.039; I = 33.7%), and the effects were marked in the subgroup in which the duration of prone positioning was more than 10 hr/session, compared with the subgroup with a short-term duration of prone positioning (odds ratio, 0.62; 9% CI, 0.48–0.79; p = 0.039; pinteraction = 0.015). Prone positioning was significantly associated with pressure ulcers (odds ratio, 1.49; 95% CI, 1.18–1.89; p = 0.001; I = 0.0%) and major airway problems (odds ratio, 1.55; 95% CI, 1.10–2.17; p = 0.012; I = 32.7%).
CONCLUSIONS:Ventilation in the prone position significantly reduced overall mortality in patients with severe acute respiratory distress syndrome. Sufficient duration of prone positioning was significantly associated with a reduction in overall mortality. Prone ventilation was also significantly associated with pressure ulcers and major airway problems. |
doi_str_mv | 10.1097/CCM.0000000000000122 |
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DATA SOURCES:PubMed, EMBASE, BioMed Central, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and conference proceedings through May 2013.
STUDY SELECTION:Randomized controlled trial comparing overall mortality of prone-versus-supine positioning in patients with acute respiratory distress syndrome.
DATA EXTRACTION:Data were extracted for populations, interventions, outcomes, and risk of bias. The prespecified primary endpoint was overall mortality, using the longest available follow-up in each study. The odds ratio with 95% CI was the effect measure.
DATA SYNTHESIS:This analysis included 11 randomized controlled trial, 2,246 total adult patients, and 1,142 patients ventilated in the prone position. Prone positioning during ventilation significantly reduced overall mortality in the random-effect model (odds ratio, 0.77; 95% CI, 0.59–0.99; p = 0.039; I = 33.7%), and the effects were marked in the subgroup in which the duration of prone positioning was more than 10 hr/session, compared with the subgroup with a short-term duration of prone positioning (odds ratio, 0.62; 9% CI, 0.48–0.79; p = 0.039; pinteraction = 0.015). Prone positioning was significantly associated with pressure ulcers (odds ratio, 1.49; 95% CI, 1.18–1.89; p = 0.001; I = 0.0%) and major airway problems (odds ratio, 1.55; 95% CI, 1.10–2.17; p = 0.012; I = 32.7%).
CONCLUSIONS:Ventilation in the prone position significantly reduced overall mortality in patients with severe acute respiratory distress syndrome. Sufficient duration of prone positioning was significantly associated with a reduction in overall mortality. Prone ventilation was also significantly associated with pressure ulcers and major airway problems.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0000000000000122</identifier><identifier>PMID: 24368348</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Humans ; Intensive care medicine ; Medical sciences ; Patient Positioning - adverse effects ; Patient Positioning - methods ; Patient Positioning - mortality ; Pneumology ; Prone Position - physiology ; Respiration, Artificial - adverse effects ; Respiration, Artificial - methods ; Respiration, Artificial - mortality ; Respiratory Distress Syndrome, Adult - mortality ; Respiratory Distress Syndrome, Adult - therapy ; Respiratory system : syndromes and miscellaneous diseases ; Treatment Outcome</subject><ispartof>Critical care medicine, 2014-05, Vol.42 (5), p.1252-1262</ispartof><rights>2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3352-b2219a6690a00a8a4369203e6d118a9970b67564435d46b2e6a12e0269d337be3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28438126$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24368348$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Joo Myung</creatorcontrib><creatorcontrib>Bae, Won</creatorcontrib><creatorcontrib>Lee, Yeon Joo</creatorcontrib><creatorcontrib>Cho, Young-Jae</creatorcontrib><title>The Efficacy and Safety of Prone Positional Ventilation in Acute Respiratory Distress Syndrome: Updated Study-Level Meta-Analysis of 11 Randomized Controlled Trials</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:The survival benefit of prone positioning during mechanical ventilation for acute respiratory distress syndrome has been a matter of debate. Recent multicenter randomized controlled trials have shown a significant reduction of 28-day and 90-day mortality associated with prone positioning during mechanical ventilation for severe acute respiratory distress syndrome. We performed an up-to-date meta-analysis on this topic and elucidated the effect of prone positioning on overall mortality and associated complications.
DATA SOURCES:PubMed, EMBASE, BioMed Central, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and conference proceedings through May 2013.
STUDY SELECTION:Randomized controlled trial comparing overall mortality of prone-versus-supine positioning in patients with acute respiratory distress syndrome.
DATA EXTRACTION:Data were extracted for populations, interventions, outcomes, and risk of bias. The prespecified primary endpoint was overall mortality, using the longest available follow-up in each study. The odds ratio with 95% CI was the effect measure.
DATA SYNTHESIS:This analysis included 11 randomized controlled trial, 2,246 total adult patients, and 1,142 patients ventilated in the prone position. Prone positioning during ventilation significantly reduced overall mortality in the random-effect model (odds ratio, 0.77; 95% CI, 0.59–0.99; p = 0.039; I = 33.7%), and the effects were marked in the subgroup in which the duration of prone positioning was more than 10 hr/session, compared with the subgroup with a short-term duration of prone positioning (odds ratio, 0.62; 9% CI, 0.48–0.79; p = 0.039; pinteraction = 0.015). Prone positioning was significantly associated with pressure ulcers (odds ratio, 1.49; 95% CI, 1.18–1.89; p = 0.001; I = 0.0%) and major airway problems (odds ratio, 1.55; 95% CI, 1.10–2.17; p = 0.012; I = 32.7%).
CONCLUSIONS:Ventilation in the prone position significantly reduced overall mortality in patients with severe acute respiratory distress syndrome. Sufficient duration of prone positioning was significantly associated with a reduction in overall mortality. Prone ventilation was also significantly associated with pressure ulcers and major airway problems.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Medical sciences</subject><subject>Patient Positioning - adverse effects</subject><subject>Patient Positioning - methods</subject><subject>Patient Positioning - mortality</subject><subject>Pneumology</subject><subject>Prone Position - physiology</subject><subject>Respiration, Artificial - adverse effects</subject><subject>Respiration, Artificial - methods</subject><subject>Respiration, Artificial - mortality</subject><subject>Respiratory Distress Syndrome, Adult - mortality</subject><subject>Respiratory Distress Syndrome, Adult - therapy</subject><subject>Respiratory system : syndromes and miscellaneous diseases</subject><subject>Treatment Outcome</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kdtu1DAQhi0EotvCGyDkGyRuUnxInJi7VSgHaSuqdsttNEkmWoM33toOVfo8PChe7XIQF8zNjKVv_n-sn5AXnJ1zpss3dX15zv4uLsQjsuCFZBkTWj4mC8Y0y2Su5Qk5DeFrQvKilE_JicilqmReLciP9QbpxTCYDrqZwtjTGxgwztQN9Mq7EemVCyYaN4KlX3CMxsL-Rc1Il90UkV5j2BkP0fmZvjMhegyB3sxj790W39LbXQ8Rk2yc-jlb4Xe09BIjZMukOAcT9k6c0-vk7bbmIaG1G6N31qZx7Q3Y8Iw8GVLD58d-Rm7fX6zrj9nq84dP9XKVdVIWImuF4BqU0gwYgwrSJ7VgElXPeQVal6xVZaHyXBZ9rlqBCrhAJpTupSxblGfk9UF3593dhCE2WxM6tBZGdFNoeMHLnLGKiYTmB7TzLgSPQ7PzZgt-bjhr9vk0KZ_m33zS2sujw9Rusf-99CuQBLw6AhA6sIOHsTPhD1flsuJCJa46cPfORvThm53u0TcbBBs3_7_hJzCyqSk</recordid><startdate>201405</startdate><enddate>201405</enddate><creator>Lee, Joo Myung</creator><creator>Bae, Won</creator><creator>Lee, Yeon Joo</creator><creator>Cho, Young-Jae</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201405</creationdate><title>The Efficacy and Safety of Prone Positional Ventilation in Acute Respiratory Distress Syndrome: Updated Study-Level Meta-Analysis of 11 Randomized Controlled Trials</title><author>Lee, Joo Myung ; Bae, Won ; Lee, Yeon Joo ; Cho, Young-Jae</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3352-b2219a6690a00a8a4369203e6d118a9970b67564435d46b2e6a12e0269d337be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Medical sciences</topic><topic>Patient Positioning - adverse effects</topic><topic>Patient Positioning - methods</topic><topic>Patient Positioning - mortality</topic><topic>Pneumology</topic><topic>Prone Position - physiology</topic><topic>Respiration, Artificial - adverse effects</topic><topic>Respiration, Artificial - methods</topic><topic>Respiration, Artificial - mortality</topic><topic>Respiratory Distress Syndrome, Adult - mortality</topic><topic>Respiratory Distress Syndrome, Adult - therapy</topic><topic>Respiratory system : syndromes and miscellaneous diseases</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Joo Myung</creatorcontrib><creatorcontrib>Bae, Won</creatorcontrib><creatorcontrib>Lee, Yeon Joo</creatorcontrib><creatorcontrib>Cho, Young-Jae</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Joo Myung</au><au>Bae, Won</au><au>Lee, Yeon Joo</au><au>Cho, Young-Jae</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Efficacy and Safety of Prone Positional Ventilation in Acute Respiratory Distress Syndrome: Updated Study-Level Meta-Analysis of 11 Randomized Controlled Trials</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2014-05</date><risdate>2014</risdate><volume>42</volume><issue>5</issue><spage>1252</spage><epage>1262</epage><pages>1252-1262</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:The survival benefit of prone positioning during mechanical ventilation for acute respiratory distress syndrome has been a matter of debate. Recent multicenter randomized controlled trials have shown a significant reduction of 28-day and 90-day mortality associated with prone positioning during mechanical ventilation for severe acute respiratory distress syndrome. We performed an up-to-date meta-analysis on this topic and elucidated the effect of prone positioning on overall mortality and associated complications.
DATA SOURCES:PubMed, EMBASE, BioMed Central, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and conference proceedings through May 2013.
STUDY SELECTION:Randomized controlled trial comparing overall mortality of prone-versus-supine positioning in patients with acute respiratory distress syndrome.
DATA EXTRACTION:Data were extracted for populations, interventions, outcomes, and risk of bias. The prespecified primary endpoint was overall mortality, using the longest available follow-up in each study. The odds ratio with 95% CI was the effect measure.
DATA SYNTHESIS:This analysis included 11 randomized controlled trial, 2,246 total adult patients, and 1,142 patients ventilated in the prone position. Prone positioning during ventilation significantly reduced overall mortality in the random-effect model (odds ratio, 0.77; 95% CI, 0.59–0.99; p = 0.039; I = 33.7%), and the effects were marked in the subgroup in which the duration of prone positioning was more than 10 hr/session, compared with the subgroup with a short-term duration of prone positioning (odds ratio, 0.62; 9% CI, 0.48–0.79; p = 0.039; pinteraction = 0.015). Prone positioning was significantly associated with pressure ulcers (odds ratio, 1.49; 95% CI, 1.18–1.89; p = 0.001; I = 0.0%) and major airway problems (odds ratio, 1.55; 95% CI, 1.10–2.17; p = 0.012; I = 32.7%).
CONCLUSIONS:Ventilation in the prone position significantly reduced overall mortality in patients with severe acute respiratory distress syndrome. Sufficient duration of prone positioning was significantly associated with a reduction in overall mortality. Prone ventilation was also significantly associated with pressure ulcers and major airway problems.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>24368348</pmid><doi>10.1097/CCM.0000000000000122</doi><tpages>11</tpages></addata></record> |
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subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Humans Intensive care medicine Medical sciences Patient Positioning - adverse effects Patient Positioning - methods Patient Positioning - mortality Pneumology Prone Position - physiology Respiration, Artificial - adverse effects Respiration, Artificial - methods Respiration, Artificial - mortality Respiratory Distress Syndrome, Adult - mortality Respiratory Distress Syndrome, Adult - therapy Respiratory system : syndromes and miscellaneous diseases Treatment Outcome |
title | The Efficacy and Safety of Prone Positional Ventilation in Acute Respiratory Distress Syndrome: Updated Study-Level Meta-Analysis of 11 Randomized Controlled Trials |
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