TITLE

Effect of mechanical ventilation in the prone position on clinical outcomes in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis

AUTHOR(S)
Sud, Sachin; Sud, Maneesh; Friedrich, Jan O.; Adhikari, Neill K. J.
PUB. DATE
April 2008
SOURCE
CMAJ: Canadian Medical Association Journal;4/22/2008, Vol. 178 Issue 9, p1153
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Mechanical ventilation in the prone position is used to improve oxygenation in patients with acute hypoxemic respiratory failure. We sought to determine the effect of mechanical ventilation in the prone position on mortality, oxygenation, duration of ventilation and adverse events in patients with acute hypoxemic respiratory failure. Methods: In this systematic review we searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and Science Citation Index Expanded for articles published from database inception to February 2008. We also conducted extensive manual searches and contacted experts. We extracted physiologic data and clinically relevant outcomes. Results: Thirteen trials that enrolled a total of 1559 patients met our inclusion criteria. Overall methodologic quality was good. In 10 of the trials (n = 1486) reporting this outcome, we found that prone positioning did not reduce mortality among hypoxemic patients (risk ratio [RR] 0.96, 95% confidence interval [CI] 0.84-1.09; p = 0.52). The lack of effect of ventilation in the prone position on mortality was similar in trials of prolonged prone positioning and in patients with acute lung injury. In 8 of the trials (n = 633), the ratio of partial pressure of oxygen to inspired fraction of oxygen on day 1 was 34% higher among patients in the prone position than among those who remained supine (p < 0.001); these results were similar in 4 trials on day 2 and in 5 trials on day 3. In 9 trials (n = 1206), the ratio in patients assigned to the prone group remained 6% higher the morning after they returned to the supine position compared with patients assigned to the supine group (p = 0.07). Results were quantitatively similar but statistically significant in 7 trials on day 2 and in 6 - trials on day 3 (p = 0.001). In 5 trials (n = 1004), prone positioning was associated with a reduced risk of ventilator-associated pneumonia (RR 0.81, 95% CI 0.66-0.99; p = 0.04) but not with a reduced duration of ventilation. In 6 trials (n = 504), prone positioning was associated with an increased risk of pressure ulcers (RR 1.36, 95% CI 1.07-1.71; p = 0.01). Most analyses found no to moderate between-trial heterogeneity.
ACCESSION #
31625516

 

Related Articles

  • It's Time to Reappraise the Impact of Auto-PEEP. Shih-Chi Ku // Respiratory Care;Feb2016, Vol. 61 Issue 2, p258 

    The article discusses a study by G. Natalini et al to address and assess the factors contributing to the development of auto-PEEP in subjects receiving mechanical ventilation without an active ventilator trigger. It cites several implications of the study such as clarifying and measuring...

  • Influenza A (H1N1)-associated pneumonia. Nicolini, Antonello; Claudio, Simonassi; Rao, Fabrizio; Ferrera, Lorenzo; Isetta, Michele; Bonfiglio, Monica // Jornal Brasileiro de Pneumologia;sep2011, Vol. 37 Issue 5, p621 

    Objective: To describe the characteristics of patients with influenza A (H1N1)-associated pneumonia treated at two hospitals in the region of Liguria, Italy, as well as to describe their treatment and outcomes. Methods: This was a prospective observational study including all patients older than...

  • Role of noninvasive ventilation in weaning frommechanical ventilation in patients of chronic obstructive pulmonary disease: An Indian experience. Prasad, Shiva B. N.; Chaudhry, Dhruva; Khanna, Rajan // Indian Journal of Critical Care Medicine;Oct-Dec2009, Vol. 13 Issue 4, p207 

    Background: Endotracheal intubation and mechanical ventilation (MV) are often needed in patients of chronic obstructive pulmonary disease (COPD) with acute hypercapnic respiratory failure. The rate of weaning failure is high and prolonged MV increases intubation associated complications....

  • Mechanical ventilation induces inflammation, lung injury, and extra-pulmonary organ dysfunction in experimental pneumonia. Dhanireddy, Shireesha; Altemeier, William A.; Matute-Bello, Gustavo; O'Mahony, D. Shane; Glenny, Robb W.; Martin, Thomas R.; Liles, W. Conrad // Laboratory Investigation (00236837);Aug2006, Vol. 86 Issue 8, p790 

    Mechanical ventilation (MV) is frequently employed for the management of critically ill patients with respiratory failure. A major complication of mechanical ventilation (MV) is the development of ventilator-associated pneumonia (VAP), in which Staphylococcus aureus is a prominent pathogen....

  • Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review. Burns, Karen E. A.; Meade, Maureen O.; Premji, Azra; Adhikari, Neill K. J. // CMAJ: Canadian Medical Association Journal;2/18/2014, Vol. 186 Issue 3, pE112 

    Background: Noninvasive ventilation has been studied as a means of reducing complications among patients being weaned from invasive mechanical ventilation. We sought to summarize evidence comparing noninvasive and invasive weaning and their effects on mortality. Methods: We identified relevant...

  • Ventilação mecânica não invasiva em uma paciente com pancreatite aguda e insuficiência respiratória. Franco de Godoy, Armando Carlos; Araújo Calderan, Thiago Rodrigues; Fraga, Gustavo Pereira // Jornal Brasileiro de Pneumologia;sep/oct2012, Vol. 38 Issue 5, p677 

    No abstract available.

  • Trends in Prevalence and Prognosis in Subjects With Acute Chronic Respiratory Failure Treated With Noninvasive and/or Invasive Ventilation. Gacouin, Arnaud; Jouneau, Stephane; Letheulle, Julien; Kerjouan, Mallory; Bouju, Pierre; Fillatre, Pierre; Le Tulzo, Yves; Tadié, Jean Marc // Respiratory Care;Feb2015, Vol. 60 Issue 2, p210 

    BACKGROUND: The pattern and outcome of noninvasive ventilation (NIV) use in patients with acute or chronic respiratory disease other than COPD is not well known. The aims of this study were to investigate trends over time in underlying respiratory diseases, use of NIV, and outcomes in COPD and...

  • Oil instillation pneumonia- A social evil. Chetan, Ginigeri; Ramar, Rathi Sharmila; Narayanan, P.; Vishnu Bhat, B.; Srinivasan, S. // Current Pediatric Research;Oct2009, Vol. 13 Issue 1/2, p39 

    In the current times of information empowerment, certain age-old socio-cultural practices such as the local custom of instilling oil into the nose and mouth of infants continue to be a major cause of morbidity and mortality in infants. Aim: To evaluate the magnitude of the problem of oil...

  • Noninvasive Mechanical Ventilation in the Treatment of Community-Acquired Pneumonia. Ortega-González, Ángel; Cobos-Ceballos, María Jesús; Serrano-Rebollo, José Carlos; Vargas-Hidalgo, Teresa; Gómez-Fernández, Máximo; García-López, José Javier; Celdrán-Gil, José // Current Respiratory Medicine Reviews;2010, Vol. 6 Issue 3, p167 

    Noninvasive mechanical ventilation (NIV) is an effective treatment in acute hypercapnic respiratory failure associated with exacerbated chronic obstructive pulmonary disease and obesity hypoventilation syndrome, among other respiratory diseases. There is less scientific evidence on its...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics