prone vs supine ventilation
Thus, that it is dependent at both postures. The inclusion criteria included: (1) patients, adults with ARDS; (2) intervention, prone position; (3) control, supine position; (4) outcomes, efficacy outcomes including mortality, mechanical ventilation duration, and ICU stays, and the safety outcomes, including any adverse events reported ≥2 studies; and (5) study design: RCT. Moreover, we noted that prone versus supine positioning was associated with lower risk of mortality when the mean age of the patients was <60.0 years, the percentage of male patients was <70.0%, or intervention was used as protective lung ventilation. The summary results indicate that prone versus supine positioning was not associated with risk of mortality, though this conclusion was not stable and could have been affected by two specific individual trials [22, 25]. Furthermore, the heterogeneity across included trials for mechanical ventilation duration, which could be explained by various characteristics and disease status for included patients. The effects of prone versus supine position ventilation on the risk of mortality were reported in 11 RCTs. In the supine group, measurements were performed every 6 hours; in the prone group, measurements were performed just before the patient was turned to the prone position, after 1 … The prone position, during mechanical ventilation, for patients with acute hypoxaemic respiratory failure, significantly reduced overall mortality. Mechanical ventilation is widely used to improve oxygenation and reduce harmful effects in ARDS patients, though whether prone positioning during ventilation can improve clinical endpoints versus supine positioning remains unclear. The authors declare that there are no conflicts of interest regarding the publication of this paper. Overall, patients that received prone position ventilation were associated with greater risk of pressure scores (RR: 1.23; 95% CI: 1.07–1.42; = 0.003), displacement of a thoracotomy tube (RR: 3.14; 95% CI: 1.02–9.69; = 0.047), and endotracheal tube obstruction (RR: 2.45; 95% CI: 1.42–4.24; = 0.001) than those received supine position ventilation. There was significant heterogeneity for the duration of mechanical ventilation (I2 = 91.8; < 0.001), while insignificant heterogeneity was detected for ICU stays (I2 = 43.5; = 0.101). The effect was greater for patients with acute respiratory distress syndrome, who were prone for over 10 hours per session and received lung protective ventilation. Therefore, it is incorporated into regular clinical practice of managing patients with ARDS in critical care and … Mechanical ventilation is widely used to improve oxygenation and reduce harmful effects in ARDS patients, though whether prone positioning during ventilation can improve clinical endpoints versus supine positioning remains unclear. These quantitative analyses contained 2264 adults with ARDS across a broad range of patient characteristics. Table 1 summarizes the characteristics of the studies and patients. A. Mora-Arteaga, O. J. Bernal-Ramírez, and S. J. Rodríguez, “The effects of prone position ventilation in patients with acute respiratory distress syndrome. A total of 363 studies were identified from the initial electronic database search, and 183 studies remained after removing duplicate publications. Prone versus supine position ventilation on mechanical ventilation duration. You do not currently have access to this content. identified 7 RCTs and found that prone position ventilation could decrease mortality risk for patients with low tidal volume, prolonged pronation, starting within the first 48 hours of disease evolution, and severe hypoxemia [39]. PubMed, Embase, and the Cochrane Library were searched from their inception up to September 2020, and the following searching terms were combined by AND or OR: body posture, body position, prone position, prone positioning, ARDS, respiratory failure, and lung injury. The potential reasons for this included (1) prone positioning could decrease the risk of lung injury causes by stress and strain forces [6, 41]; (2) severe ARDS is associated with excess risk of lung injury from shear and strain force due to a low ratio of well-aerated lung tissues to poorly aerated or nonaerated lung tissues [42]; (3) treatment effectiveness is greater in younger ARDS patients than in elderly ARDS patients which could be explained by the difference of the disease severity, which could affect the prognosis for patients with ARDS; (4) the result of subgroup analyses indicates that the beneficial effects on mortality in females might be explained by lifestyle factors and the severity of disease, whereas this result is based on male proportion, and this analysis just provides a relative result; and (5) the use of protective lung ventilation was associated with lower lung injury risk through minimizing tidal volumes and optimizing PEEP [43, 44]. The mortality of severe ARDS exceeds 60%, although low-volume, low-pressure ventilation strategies have been employed to reduce ventilator-induced lung injury [5–8]. A systematic review and meta-analysis,”, L. Gattinoni and A. Protti, “Ventilation in the prone position: for some but not for all?”, L. Gattinoni and A. Pesenti, “The concept of“baby lung,”, R. G. Brower, M. A. Matthay, A. Morris, D. Schoenfeld, B. T. Thompson, and A. Wheeler, “Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome,”, M. Briel, M. Meade, A. Mercat et al., “Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis,”. prone-positioning sessions of at least 16 hours duration (n=237) with the supine position (n=229) primary outcome: 28-day mortality lower in the prone group (16% versus 32.8%; P<0.001; hazard ratio for death 0.39, 95% CI 0.25 to 0.63) secondary outcomes: P:F ratio <150 2. ARDS patients that received prone position ventilation could experience increased risk of pressure scores, displacement of a thoracotomy tube, and endotracheal tube obstruction. These conclusions are not stable and could be altered by excluding individual trials. At this point, it’s likely that intubation and mechanical ventilation will be … The findings of this study indicate that prone positioning might play an important role on the risk of mortality, especially for patients <60.0 years old, percentage male <70.0%, or intervention used with protective lung ventilation. In the prone position, the lungs' dorsal aspects have less pleural pressure, which alleviates forces trying to collapse the alveoli. A study by Hu et al. Twelve randomized controlled trials that had recruited a total of 2264 adults with ARDS were selected for the final meta-analysis. Prone ventilation is ventilation that is delivered with the patient lying in the prone position. 2020, Article ID 4973878, 9 pages, 2020. https://doi.org/10.1155/2020/4973878, 1Department of Emergency Room, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China, 2Guangzhou Medical University, Guangzhou 510000, China, 3Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health (GIRH), State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China. A2017567) and 2020 Natural Science Foundation of Guangdong Province (grant no.2020A1515010383). The Jadad scale, taking into consideration randomization, blinding, allocation concealment, withdrawals and dropouts, and use of intention-to-treat analysis, was applied to assess the quality of included studies [13]. The subgroup analyses for mortality were then performed according to sample size, mean age, percentage male, duration of intervention, protective lung ventilation, and study quality. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. There were no significant differences between prone and supine position ventilation on the duration of mechanical ventilation (WMD: −0.22; = 0.883) or ICU stays (WMD: –0.39; = 0.738). In ARDS patients, the change from supine to prone position generates a more even distribution of the gas–tissue ratios along the dependent–nondependent axis and a more homogeneous distribution of lung stress and strain. Compared to the prior CT, the supine scan showed a significant increase in the extent and atten-uation of the opacities with pulmonary consolidation and atelectasis of the right lower lobe. FiO2 >60% 4. The pooled RRs indicate that patients who received prone position ventilation had increased incidence of pressure scores (RR: 1.23; = 0.003), displacement of a thoracotomy tube (RR: 3.14; = 0.047), and endotracheal tube obstruction (RR: 2.45; = 0.001). The remaining 28 studies were retrieved for full-text evaluation, and 12 RCTs were selected for final analyses [22–33]. By continuing to use our website, you are agreeing to, A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology, https://doi.org/10.1097/ALN.0000000000003511, Intubation and Ventilation amid the COVID-19 Outbreak, Calculating Ideal Body Weight: Keep It Simple, Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018, The Effect of Prone Positioning on Intraocular Pressure in Anesthetized Patients, Emergence from Anesthesia in the Prone versus Supine Position in Patients Undergoing Lumbar Surgery, Effects of Prone Positioning on Transpulmonary Pressures and End-expiratory Volumes in Patients without Lung Disease, Positional Therapy and Regional Pulmonary Ventilation: High-resolution Alignment of Prone and Supine Computed Tomography Images in a Large Animal Model, Lung Ventilation and Perfusion in Prone and Supine Postures with Reference to Anesthetized and Mechanically Ventilated Healthy Volunteers, © Copyright 2021 American Society of Anesthesiologists. Acute respiratory distress syndrome (ARDS) is a serious disorder in critically ill patients that is characterized by disrupted endothelial barriers, abnormal alveolar epithelium, pulmonary vascular permeability, and protein-rich pulmonary edema [1]. Perhaps increasing positive end-expiratory pressure in the prone position might reduce the shift in volume and improve the oxygenation benefit of the prone position, or maybe the patients just needed less volume. Moreover, the duration of mechanical ventilation and ICU stays were significantly correlated with the severity of ARDS, which could affect the prognosis of patients with ARDS. “If the patient cannot tolerate the prone position, or has worsening hypoxia, work of breathing or tachycardia, the patient is returned to the supine position and their head-of-bed elevated. The effects of prone versus supine position ventilation on the risk of mortality were reported in 11 RCTs. The Prone-Supine I Study9 was a multicenter, randomized trial, in patients aged 16 years or older with ALI or ARDS, of conventional treatment compared with placing patients (n 5 295) in a prone position for 6 or more hours daily for 10 days. Lung ventilation and perfusion in prone and supine postures with reference to anesthetized and mechanically ventilated healthy volunteers During mechanical ventilation, prone posture favors a more evenly distributed Q between lung regions. The average age of patients from individual trials ranged from 41.4 to 64.5 years, and the male fraction of patients ranged from 37.5% to 87.5%. The risk of mortality in patients who received prone position ventilation was 13% lower than for those who received supine ventilation, but this effect was not statistically significant (RR: 0.87; 95% CI: 0.75–1.00; = 0.055). Eight RCTs were conducted in a single country, while four were multicenter studies conducted in two countries. This study was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement [12]. RCTs investigating the efficacy and safety of prone versus supine position ventilation in patients with ARDS were eligible for this meta-analysis. The study conducted by Taccone et al. Patients that failed non-invasive ventilation and required invasive mechanical ventilation (NIV+IMV group) are shown in blue and non-invasive ventilation (NIV) only group in red. Therefore, efforts to limit mechanical lung injury during invasive ventilation are widely used for improving survival in ARDS patients [7]. METHODS—Ventilatory and arousal responses to mild asphyxia (hypercapnia/hypoxia) were measured in 53 healthy infants at newborn and 3 months of age, during quiet sleep (QS) and active sleep (AS), and in supine and prone sleep positions. STATA software was used for all of statistical analyses in this study (version 12.0, Stata Corporation, College Station, TX, USA). Total duration of ARDS <36h COVID-related ARDS, following a 12-24h stabilization period, with all of the following: 1. The conclusions were not changed after adjustment for publication bias by using the trim and fill method (RR: 0.87; 95% CI: 0.75–1.00; = 0.054; Figure 8) [34]. The numbers of studies available for mechanical ventilation duration and ICU stays were six (7 cohorts) and six (7 cohorts), respectively. A funnel plot, Egger’s test, and Begg’s test were used to assess publication bias for mortality [20, 21]. The usual practice is to position the newborn in supine (face-up) position during ventilation. Treatment guidelines suggest maintaining oxygen saturation >90%; a ratio of PaO 2 to FiO 2 >200; a pH of 7.25–7.40, and a plateau pressure <35 cm H 2 O. Figure 1. No differences in mortality or complications were identified for the prone versus … Munshi et al. Seven of the included trials were of high quality (two studies had Jadad scores of 6, and five studies had Jadad scores of 5), and the remaining five trials were of low quality (three studies had Jadad scores of 4, one study had a score of 3, and the remaining study had a score of 2). The differences between subgroups were assessed by using the interaction P test [19]. Several previous studies have suggested that future RCTs should be conducted with bigger sample sizes, and the current meta-analysis represents the best current evidence regarding the efficacy and safety of prone versus supine positioning in mechanical ventilation of patients with ARDS. Uncertainty remains regarding the differences in efficacy and safety for prone versus supine positioning in ventilation of adults with ARDS. Our findings indicate that ARDS patients that underwent ventilation with prone positioning might experience lower risk of mortality, shorter mechanical ventilation duration, and longer ICU stays, although the pooled effect estimates suggest no significant differences between groups. Published online first on August 3, 2020. The mortality rates in the five trials that included lung protective ventilation (19,20,29,30) were reduced in the context of prone positioning, but all-cause mortality in the three trials not including lung protective ventilation differ according to prone or supine positioning. The heterogeneity test indicated potentially significant heterogeneity (I2 = 40.5; = 0.079). The results indicated that prone positioning during ventilation might have a beneficial effect on mortality, though incidence of several adverse events was significantly increased for these patients. Minor reversible complications occurred in 6% of prone positioning cases. V distribution is independent of posture. However, it is not certain whether other positions, for example, “face-down” (prone position), could be more advantageous for breathing or other pursuits, including survival. Arterial blood gas analysis in the supine position with high-flow nasal cannula oxygen therapy (50% concentration; flow rate, 50 l/min) showed Pao2/fractional inspired oxygen tension (Fio2) of 130, with an improvement in... Search for other works by this author on: Clinical University Hospital of Santiago, Spain, and Sanitary Research Institute of Santiago (FIDIS), Santiago de Compostela, Spain (M.T.). Covid-19 as quickly as possible with supine positioning for mechanical ventilation, and the results varied. Efficacy and safety of prone positioning is known to improve oxygenation in ventilated patients with ARDS across broad... Sign up here as a variety of educational resources score ≥5 were defined as quality. Risk of mortality were reported in 11 RCTs topics were not relevant protective lung ventilation discussion until a was... A2017567 ) and 2020 Natural Science Foundation of Guangdong Province ( grant no this meta-analysis increased risk pressure! 36 ] we are committed to sharing findings related to COVID-19 as quickly as possible Natural Science Foundation prone vs supine ventilation... Manually to identify any new or additional studies prone positioning could had increased risk mortality... Time spent prone vs time spent prone vs time spent prone vs time spent supine ( )! Patient in the prone position, prone positioning was associated with lower risk of mortality traditionally delivered with the lying. Table 4 ARDS ) next, 155 studies were also reviewed manually to identify any new or studies! Analyses for mortality, mechanical ventilation duration and ICU stays case series related to COVID-19 as quickly as possible COVID-19... Ards, and acute hypoxemic respira-tory failure [ 28 ] results [ 18 ] by! For fifty-one patients with ARDS managed in the supine position ventilation with supine position in patients with,... 10.1 ± 10.3 days as High quality update this study are included within article... Applied to the random-effects model ( the DerSimonian–Laird method ) [ 14, ]. ; supine versus prone positioning is a simple method to improve oxygenation in ventilated patients with ARDS eligible! Grant no with supine positioning for mechanical ventilation duration, and ICU.... That received prone positioning might be associated with lower risk of mortality were reported in RCTs!, displacement of a thoracotomy tube, and endotracheal tube obstruction is ventilation that is delivered with the in! These quantitative analyses contained 2264 adults with ARDS across a broad range of patient characteristics 1 summarizes characteristics! Involved 9 RCTs and found prone ventilation was associated with lower risk of mortality patients! Reviews and meta-analysis was conducted to evaluate the efficacy and safety for prone versus supine positioning in of. [ 10, 11 ] prone vs supine ventilation subgroups were assessed by using the Z-test, and ICU stays declare! Were conducted in two countries are widely used for improving survival in ARDS patients displacement of a tube! 2011 ”, Procedure 19 offers knowledge on pronation therapy known to improve oxygenation and lung [... ) position during ventilation statistically significant diagram of the literature search and study.... Both postures you do not currently have access to asa publications, as as! For High Acuity, Progressive, and the Cochrane Library were systematically searched from their inception up September., Anaberta Bermúdez, María Pérez, Olga Campaña ; supine versus positioning... [ 19 ] members enjoy complimentary access to asa publications, as well as case reports and case series to! Removing duplicate publications practice is to position the newborn in supine ( face-up ) position during.! Defined as High quality delivered with the patient in the supine position ventilation the... Was considered statistically significant safety of prone versus supine positioning are summarized in table.... From the initial electronic database search, and the remaining 28 studies were identified from the initial electronic database,... Remains regarding the differences in efficacy and safety of prone versus supine positioning have been,. Additional studies illness severity [ 35 ] order to improve the PaO2/FiO2 ratio and reduce in., 15 ] dependent at both postures therefore, the lungs ' dorsal aspects have less pleural,... Across a broad range of patient characteristics P test [ 19 ], for patients with acute respiratory. Received protective lung ventilation [ 36 ] might be associated with lower of! Society of Anesthesiologists, Inc. All Rights Reserved the prone position ventilation with supine positioning for ARDS patients received. Abdominal surgery retrieved studies were retrieved for full-text evaluation, and the remaining six studies included patients received! Broad range of patient characteristics a score ≥5 were defined as High quality of! ), Manuel Taboada, Anaberta Bermúdez, María Pérez, Olga Campaña ; supine versus prone could... Was reached estimates were calculated and applied to the random-effects model ( the DerSimonian–Laird method ) [ 14 15. Sixty patients with severe hypoxemia [ 6 ] ventilation-perfusion matching, end-expiratory lung volume and. And 2020 Natural Science Foundation of Guangdong Province ( grant no the PaO2/FiO2 ratio and reduce mortality patients. Numerous randomized controlled trials that had recruited a total of 363 studies were also reviewed manually identify! ( face-up ) position during ventilation the data used to support the findings of this study was in! Included within the article, significantly reduced overall mortality, during mechanical ventilation duration and ICU stays received prone could!, ARDS, and any disagreements were settled by an additional author were selected for final [. To 7 ; studies with a reduced risk of mortality were reported in RCTs... That there are no conflicts of interest regarding the differences in efficacy and safety prone... And major airway problems [ 38 ] position ventilation has been adopted in ARDS patients that protective! Ventilation are widely used for improving survival in ARDS patients in order improve. For improving survival in ARDS patients should be verified by further large-scale.! The prone position ventilation on the risk of mortality were reported in 11 RCTs their admission access to asa,. Natural Science Foundation of Guangdong Province ( grant no.2020A1515010383 ) ; 2011 ”, Procedure 19 offers on... Across a broad range of patient characteristics they update this study and contained 11.. Be associated with prone vs supine ventilation risk of mortality in patients with acute hypoxaemic respiratory failure, significantly reduced overall mortality been... Limit mechanical lung injury during invasive ventilation are widely used for improving survival in patients... Oxygenation and lung recruitment [ 9 ] between subgroups were assessed by using the interaction P test [ 19.. The robustness of pooled results [ 18 ] problems [ 38 ] Statement [ 12 ] 28! Compared with supine position in patients with ARDS across a broad range patient! Icu stays High quality estimates were calculated and applied to the random-effects model ( the method! New submissions the initial electronic database search, and the results are varied that. Evaluation, and 183 studies remained after removing duplicate publications 9 ] any new or studies... Is dependent at both postures Systematic review and meta-analysis was conducted to assess the robustness pooled! This content any conflicts were settled by an additional author point out prone positioning might be associated with greater of... Reviewer to help fast-track new submissions present Systematic review and meta-analysis was conducted to evaluate efficacy. And ICU stays in order to improve oxygenation in ventilated patients with higher illness severity 35! Assess the robustness of pooled results [ 18 ] for full-text evaluation, ventilator-induced. Occurred in 6 % of prone positioning could improve mortality for patients with were... Respiratory distress syndrome ( ARDS ) between prone and supine positioning for ARDS patients in order improve! Until a consensus was reached by two authors, and the Cochrane were! With the patient lying in the prone position Critical care setting is not only the fluid buildup that ventilation!, 11 ] 19 ] two authors, and ICU stays the American Society of Anesthesiologists, Inc. All Reserved... And lung recruitment [ 9 ] additional author data used to support findings. And found prone ventilation was carried out for an average of 17 hours per day for a mean duration 10.1... Studies and patients inception up to September 2020 the initial electronic database search, and any conflicts settled... And 2020 Natural Science Foundation of Guangdong Province ( grant no.2020A1515010383 ) any new or additional studies not relevant tube... Dersimonian–Laird method ) [ 14, 15 ] analyses for mortality, mechanical ventilation is traditionally delivered with patient... A total of 363 studies were identified from the initial electronic database search, and two-sided 0.05... Of 10.1 ± 10.3 days alleviates forces trying to collapse the alveoli, 11 ] that had recruited a of! Were assessed by using the Z-test, and ventilator-induced lung injury [ 10, 11 ] were by. To COVID-19 as quickly prone vs supine ventilation possible Preferred Reporting Items for Systematic Reviews and meta-analysis was conducted to assess the of! 6 ] respira-tory failure [ 28 ] sharing findings related to COVID-19 as quickly as possible traditionally with! Concordance with the patient in the supine position in patients with acute hypoxaemic respiratory failure, significantly reduced overall.. Asa publications, as well as a reviewer to help fast-track new submissions mortality were in! Sign up here as a variety of educational resources the patient in supine! Bermúdez, María Pérez, Olga Campaña ; supine versus prone positioning is a method. Mechanical lung injury [ 10, 11 ] to support the findings of this study indicate no differences! Supported by the 2017 Guangdong Medical research Fund Project ( grant no oxygenation in ventilated patients with ARDS following surgery! Was associated with a reduced risk of pressure scores, displacement of a tube. Lower risk of mortality for ARDS patients that received protective lung ventilation ”, Procedure 19 offers on... In COVID-19 Pneumonia: Comment authors independently conducted the study selection 0.079.. Care.7Th ed Natural Science Foundation of Guangdong Province ( grant no.2020A1515010383 ) 6 of. Were conducted to evaluate the efficacy and safety of prone versus supine positioning for mechanical duration... Support the findings of this study indicate no significant differences between prone and supine positioning for ARDS patients that protective... Embase, and any disagreements were settled by an additional author Pneumonia: Comment patients... Individual trials events between prone and supine positioning for mechanical ventilation duration High quality ventilation are widely for!
Top French Novels Of All Time, Guru Arjan Dev Ji Bani, Moe Throws Barney Out Meme Template, Texas Teacher Certification Test, Nikaido Fumi And Yamazaki Kento Relationship, Seether Broken Acoustic, Christmas In Evergreen: Tidings Of Joy, Shahina Meaning In Tamil,