Effect of prone positioning ventilation for mortality in severe acute respiratory distress syndrome patients: a cumulative meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YUE Weigang ¹ ,  ZHANG Zhigang ¹ , ZHANG Caiyun ¹ , YANG Liping ¹ , HE Jufang ² , HOU Yuying ² , TANG Ying ² , TIAN Jinhui ^3,4

1. The First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;
2. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P.R.China;
3. Evidence Based Medicine Center of Lanzhou University, Lanzhou, 730000, P.R.China;
4. Key Laboratory of Evidence Based Medicine and Clinical Transformation of Gansu Province, Lanzhou, 730000, P.R.China;

Corresponding author：

ZHANG Zhigang, Email: zzg3444@163.com

Keywords：

Prone positioning ventilation; Acute respiratory distress syndrome; Mortality; Cumulative meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201702002

Video：

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ObjectiveTo evaluate the effect of prone position ventilation on mortality in ARDS patients by cumulative meta-analysis.MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI, VIP, WanFang Data were searched from inception to September 30^th, 2016 to collect randomized controlled trials (RCTs) about prone position ventilation in ARDS patients. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. In accordance with the published literature or published in chronological order, cumulative meta-analysis was performed using Stata12.0 software, and the trial sequencing analysis (TSA) method was used to assess the reliability and authenticity of the results.ResultsA total of 9 RCTs involving 2 359 patients were included. The cumulative meta-analysis results showed that the prone position ventilation could reduce the mortality in ARDS patients (OR=0.60, 95%CI 0.40 to 0.90). The TSA results showed that the definite conclusion had been obtained before the desired amount of information had been reached.ConclusionThe current evidence shows that prone position ventilation is associated with decreased mortality in ARDS patients. Due to limited quality and quantity of included studies, the above results are needed to validate by more studies.

Citation： YUE Weigang, ZHANG Zhigang, ZHANG Caiyun, YANG Liping, HE Jufang, HOU Yuying, TANG Ying, TIAN Jinhui. Effect of prone positioning ventilation for mortality in severe acute respiratory distress syndrome patients: a cumulative meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(7): 792-797. doi: 10.7507/1672-2531.201702002 Copy

1.	Yadam SE, Bihler M, Balaan M, et al. Acute respiratory distress syndrome. Crit Care Nurs Q, 2016, 39(2): 190-195.
2.	Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
3.	Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet, 1967, 2(7511): 319-323.
4.	Girard TD, Bernard GR. Mechanical ventilation in ARDS: a state-of-the-art review. Chest, 2007, 131(3): 921-929.
5.	The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-1308.
6.	Przybysz TM, Heffner AC. Early treatment of severe acute respiratory distress syndrome. Emerg Med Clin North Am, 2016, 34(1): 1-14.
7.	Wang C, Wang X, Chi C, et al. Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis. Sci Rep, 2016, 6: 22855.
8.	Guerin C, Gaillard S, Lemasson S, et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA, 2004, 292(19): 2379-2387.
9.	Kacmarek RM, Villar J. Management of refractory hypoxemia in ARDS. Minerva Anestesiol, 2013, 79(10): 1173-1179.
10.	Koulouras V, Papathanakos G, Papathanasiou A, et al. Efficacy of prone position in acute respiratory distress syndrome patients: a pathophysiology-based review. World J Crit Care Med, 2016, 5(2): 121-136.
11.	Guerin C. Prone ventilation in acute respiratory distress syndrome. Eur Respir Rev, 2014, 23(132): 249-257.
12.	Cornejo RA, Díaz JC, Tobar EA, et al. Effects of prone positioning on lung protection in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med, 2013, 188(4): 440-448.
13.	Russell JA. Prone positioning in patients with acute respiratory distress syndrome. JAMA, 2010, 303(9): 832-833.
14.	Sud S, Friedrich JO, Taccone P, et al. Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med, 2010, 36(4): 585-599.
15.	Gattinoni L, Tognoni G, Pesenti A, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med, 2001, 345(8): 568-573.
16.	Guerin C, Gaillard S, Lemasson S, et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA, 2004, 292(19): 2379-2387.
17.	Voggenreiter G, Aufmkolk M, Stiletto RJ, et al. Prone positioning improves oxygenation in post-traumatic lung injury-a prospective randomized trial. J Trauma, 2005, 59(2): 333-343.
18.	Mancebo J, Fernández R, Blanch L, et al. A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med, 2006, 173(11): 1233-1239.
19.	Chan MC, Hsu JY, Liu HH, et al. Effects of prone position on inflammatory markers in patients with ARDS due to community-acquired pneumonia. J Formos Med Assoc, 2007, 106(9): 708-716.
20.	Fernandez R, Trenchs X, Klamburg J, et al. Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial. Intensive Care Med, 2008, 34(8): 1487-1491.
21.	Taccone P, Pesenti A, Latini R, et al. Prone positioning in patients with moderate and severe acute respiratory distress syndrome:a randomized controlled trial. JAMA, 2009, 302(18): 1977-1984.
22.	Charron C, Bouferrache K, Caille V, et al. Routine prone positioning in patients with severe ARDS: feasibility and impact on prognosis. Intensive Care Med, 2011, 37(5): 785-790.
23.	Guerin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med, 2013, 368(23): 2159-2168.
24.	Lee JM, Bae W, Lee YJ, et al. The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med, 2014, 42(5): 1252-1262.
25.	Sud S, Friedrich JO, Adhikari NK, et al. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ, 2014, 186(10): 381-390.
26.	Nuckton TJ, Alonso JA, Kallet RH, et al. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med, 2002, 346(17): 1281-1286.
27.	Meade MO, Herrigde MS. An evidence-based approach to acute respiratory distress syndrome. Respir Care, 2001, 46(12): 1368-1376.
28.	Albert RK, Hubmayr RD. The prone position eliminates compression of the lungs by the heart.Am J Respir Crit Care Med, 2000, 161(5): 1660-1665.
29.	Gattinoni L, Pelosi P, Vitale G, et al. Body position changes redistribute lung computed-tomographicdensity in patients with acute respiratory failure. Anesthesiology, 1991,74(1): 15-23.
30.	Richard JC, Bregeon F, Costes N, et al. Effects of prone position and positive end-expiratory pressure on lung perfusionand ventilation. Crit Care Med, 2008, 36(8): 2373-2380.
31.	Richter T, Bellani G, Scott HR, et al. Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury. Am J Respir Crit Care Med, 2005, 172(4): 480-487.

1. Yadam SE, Bihler M, Balaan M, et al. Acute respiratory distress syndrome. Crit Care Nurs Q, 2016, 39(2): 190-195.
2. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
3. Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet, 1967, 2(7511): 319-323.
4. Girard TD, Bernard GR. Mechanical ventilation in ARDS: a state-of-the-art review. Chest, 2007, 131(3): 921-929.
5. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-1308.
6. Przybysz TM, Heffner AC. Early treatment of severe acute respiratory distress syndrome. Emerg Med Clin North Am, 2016, 34(1): 1-14.
7. Wang C, Wang X, Chi C, et al. Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis. Sci Rep, 2016, 6: 22855.
8. Guerin C, Gaillard S, Lemasson S, et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA, 2004, 292(19): 2379-2387.
9. Kacmarek RM, Villar J. Management of refractory hypoxemia in ARDS. Minerva Anestesiol, 2013, 79(10): 1173-1179.
10. Koulouras V, Papathanakos G, Papathanasiou A, et al. Efficacy of prone position in acute respiratory distress syndrome patients: a pathophysiology-based review. World J Crit Care Med, 2016, 5(2): 121-136.
11. Guerin C. Prone ventilation in acute respiratory distress syndrome. Eur Respir Rev, 2014, 23(132): 249-257.
12. Cornejo RA, Díaz JC, Tobar EA, et al. Effects of prone positioning on lung protection in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med, 2013, 188(4): 440-448.
13. Russell JA. Prone positioning in patients with acute respiratory distress syndrome. JAMA, 2010, 303(9): 832-833.
14. Sud S, Friedrich JO, Taccone P, et al. Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med, 2010, 36(4): 585-599.
15. Gattinoni L, Tognoni G, Pesenti A, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med, 2001, 345(8): 568-573.
16. Guerin C, Gaillard S, Lemasson S, et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA, 2004, 292(19): 2379-2387.
17. Voggenreiter G, Aufmkolk M, Stiletto RJ, et al. Prone positioning improves oxygenation in post-traumatic lung injury-a prospective randomized trial. J Trauma, 2005, 59(2): 333-343.
18. Mancebo J, Fernández R, Blanch L, et al. A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med, 2006, 173(11): 1233-1239.
19. Chan MC, Hsu JY, Liu HH, et al. Effects of prone position on inflammatory markers in patients with ARDS due to community-acquired pneumonia. J Formos Med Assoc, 2007, 106(9): 708-716.
20. Fernandez R, Trenchs X, Klamburg J, et al. Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial. Intensive Care Med, 2008, 34(8): 1487-1491.
21. Taccone P, Pesenti A, Latini R, et al. Prone positioning in patients with moderate and severe acute respiratory distress syndrome:a randomized controlled trial. JAMA, 2009, 302(18): 1977-1984.
22. Charron C, Bouferrache K, Caille V, et al. Routine prone positioning in patients with severe ARDS: feasibility and impact on prognosis. Intensive Care Med, 2011, 37(5): 785-790.
23. Guerin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med, 2013, 368(23): 2159-2168.
24. Lee JM, Bae W, Lee YJ, et al. The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med, 2014, 42(5): 1252-1262.
25. Sud S, Friedrich JO, Adhikari NK, et al. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ, 2014, 186(10): 381-390.
26. Nuckton TJ, Alonso JA, Kallet RH, et al. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med, 2002, 346(17): 1281-1286.
27. Meade MO, Herrigde MS. An evidence-based approach to acute respiratory distress syndrome. Respir Care, 2001, 46(12): 1368-1376.
28. Albert RK, Hubmayr RD. The prone position eliminates compression of the lungs by the heart.Am J Respir Crit Care Med, 2000, 161(5): 1660-1665.
29. Gattinoni L, Pelosi P, Vitale G, et al. Body position changes redistribute lung computed-tomographicdensity in patients with acute respiratory failure. Anesthesiology, 1991,74(1): 15-23.
30. Richard JC, Bregeon F, Costes N, et al. Effects of prone position and positive end-expiratory pressure on lung perfusionand ventilation. Crit Care Med, 2008, 36(8): 2373-2380.
31. Richter T, Bellani G, Scott HR, et al. Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury. Am J Respir Crit Care Med, 2005, 172(4): 480-487.

Chinese Journal of Evidence-Based Medicine

Effect of prone positioning ventilation for mortality in severe acute respiratory distress syndrome patients: a cumulative meta-analysis

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