The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome

A meta-analysis of randomized controlled trials

So Young Park, Hyun Jung Kim, Kwan Ha Yoo, Yong Bum Park, Seo Woo Kim, Seok Jeong Lee, Eun Kyung Kim, Jung Hyun Kim, Yee Hyung Kim, Ji yong Moon, Kyung-Hoon Min, Sung Soo Park, Jinwoo Lee, Chang Hoon Lee, Jinkyeong Park, Min Kwang Byun, Sei Won Lee, Chin Kook Rlee, Ji Ye Jung, Yun Su Sim

Research output: Contribution to journalArticle

22 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)356-367
Number of pages12
JournalJournal of Thoracic Disease
Volume7
Issue number3
DOIs
Publication statusPublished - 2015 Jan 1

Fingerprint

Adult Respiratory Distress Syndrome
Prone Position
Meta-Analysis
Randomized Controlled Trials
Odds Ratio
Confidence Intervals
Safety
Mortality
Supine Position
Lung
Ventilation
Ventilator-Associated Pneumonia
Severe Acute Respiratory Syndrome
Pressure Ulcer
Incidence
MEDLINE
Respiratory Insufficiency

Keywords

  • Acute respiratory distress syndrome (ARDS)
  • Mortality
  • Prone positioning

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome : A meta-analysis of randomized controlled trials. / Park, So Young; Kim, Hyun Jung; Yoo, Kwan Ha; Park, Yong Bum; Kim, Seo Woo; Lee, Seok Jeong; Kim, Eun Kyung; Kim, Jung Hyun; Kim, Yee Hyung; Moon, Ji yong; Min, Kyung-Hoon; Park, Sung Soo; Lee, Jinwoo; Lee, Chang Hoon; Park, Jinkyeong; Byun, Min Kwang; Lee, Sei Won; Rlee, Chin Kook; Jung, Ji Ye; Sim, Yun Su.

In: Journal of Thoracic Disease, Vol. 7, No. 3, 01.01.2015, p. 356-367.

Research output: Contribution to journalArticle

Park, SY, Kim, HJ, Yoo, KH, Park, YB, Kim, SW, Lee, SJ, Kim, EK, Kim, JH, Kim, YH, Moon, JY, Min, K-H, Park, SS, Lee, J, Lee, CH, Park, J, Byun, MK, Lee, SW, Rlee, CK, Jung, JY & Sim, YS 2015, 'The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome: A meta-analysis of randomized controlled trials', Journal of Thoracic Disease, vol. 7, no. 3, pp. 356-367. https://doi.org/10.3978/j.issn.2072-1439.2014.12.49
Park, So Young ; Kim, Hyun Jung ; Yoo, Kwan Ha ; Park, Yong Bum ; Kim, Seo Woo ; Lee, Seok Jeong ; Kim, Eun Kyung ; Kim, Jung Hyun ; Kim, Yee Hyung ; Moon, Ji yong ; Min, Kyung-Hoon ; Park, Sung Soo ; Lee, Jinwoo ; Lee, Chang Hoon ; Park, Jinkyeong ; Byun, Min Kwang ; Lee, Sei Won ; Rlee, Chin Kook ; Jung, Ji Ye ; Sim, Yun Su. / The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome : A meta-analysis of randomized controlled trials. In: Journal of Thoracic Disease. 2015 ; Vol. 7, No. 3. pp. 356-367.
@article{4010c4498e0f408f92be36c0a1b37a55,
title = "The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome: A meta-analysis of randomized controlled trials",
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.",
keywords = "Acute respiratory distress syndrome (ARDS), Mortality, Prone positioning",
author = "Park, {So Young} and Kim, {Hyun Jung} and Yoo, {Kwan Ha} and Park, {Yong Bum} and Kim, {Seo Woo} and Lee, {Seok Jeong} and Kim, {Eun Kyung} and Kim, {Jung Hyun} and Kim, {Yee Hyung} and Moon, {Ji yong} and Kyung-Hoon Min and Park, {Sung Soo} and Jinwoo Lee and Lee, {Chang Hoon} and Jinkyeong Park and Byun, {Min Kwang} and Lee, {Sei Won} and Rlee, {Chin Kook} and Jung, {Ji Ye} and Sim, {Yun Su}",
year = "2015",
month = "1",
day = "1",
doi = "10.3978/j.issn.2072-1439.2014.12.49",
language = "English",
volume = "7",
pages = "356--367",
journal = "Journal of Thoracic Disease",
issn = "2072-1439",
publisher = "Pioneer Bioscience Publishing Company (PBPC)",
number = "3",

}

TY - JOUR

T1 - The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome

T2 - A meta-analysis of randomized controlled trials

AU - Park, So Young

AU - Kim, Hyun Jung

AU - Yoo, Kwan Ha

AU - Park, Yong Bum

AU - Kim, Seo Woo

AU - Lee, Seok Jeong

AU - Kim, Eun Kyung

AU - Kim, Jung Hyun

AU - Kim, Yee Hyung

AU - Moon, Ji yong

AU - Min, Kyung-Hoon

AU - Park, Sung Soo

AU - Lee, Jinwoo

AU - Lee, Chang Hoon

AU - Park, Jinkyeong

AU - Byun, Min Kwang

AU - Lee, Sei Won

AU - Rlee, Chin Kook

AU - Jung, Ji Ye

AU - Sim, Yun Su

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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.

AB - 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.

KW - Acute respiratory distress syndrome (ARDS)

KW - Mortality

KW - Prone positioning

UR - http://www.scopus.com/inward/record.url?scp=84928600792&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84928600792&partnerID=8YFLogxK

U2 - 10.3978/j.issn.2072-1439.2014.12.49

DO - 10.3978/j.issn.2072-1439.2014.12.49

M3 - Article

VL - 7

SP - 356

EP - 367

JO - Journal of Thoracic Disease

JF - Journal of Thoracic Disease

SN - 2072-1439

IS - 3

ER -