Tuesday, April 14, 2009

Tuesday April 14, 2009
Prone positioning in hypoxemic respiratory failure:
Meta-analysis of randomized controlled trials



We have seen the ups and down of prone ventilation. Kopterides did the meta-analysis to assess the effect of prone positioning on intensive care unit (ICU) and hospital mortality, days on mechanical ventilation, length of stay, incidence of ventilator-associated pneumonia (VAP) and pneumothorax, and associated complications.

Result:
  • The pooled odds ratio (OR) for the ICU mortality in the intention-to-treat analysis was 0.97 (95% confidence interval [CI], 0.77-1.22), for the comparison between prone and supine ventilated patients
  • The pooled OR for the ICU mortality in the more severely ill patients favored prone positioning (OR, 0.34; 95% CI, 0.18-0.66)
  • The duration of mechanical ventilation and the incidence of pneumothorax were not different between the 2 groups
  • The incidence of VAP was lower but not statistically significant in patients treated with prone positioning (OR, 0.81; 95% CI, 0.61-1.10)

(However)

  • Prone positioning was associated with a higher risk of pressure sores (OR, 1.49; 95% CI, 1.17-1.89) and
  • Prone positioning was associated with a trend for more complications related to the endotracheal tube (OR, 1.30; 95% CI, 0.94-1.80)

Conclusion: This meta-analysis revealed that prone positioning does not change the overall mortality, but may have benefit in the selected group of severely ill patients. It decreases the incidence of VAP, but has more pressure sores and endotracheal tube related complications.




Reference: click to get abstract

Kopterides P, Siempos I, Armaganidis A. Prone positioning in hypoxemic respiratory failure: Meta-analysis of randomized controlled trials. J of Critical Care 2009; 24(1): 89-100

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