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Review: prone positioning improved oxygenation on ventilation more than supine positioning in ARDS

C M Martin

Dr C M Martin, University of Western Ontario, London, Ontario, Canada; cmartin1@uwo.ca

QUESTION
In patients with acute respiratory distress syndrome (ARDS) on mechanical ventilation, does prone positioning result in better outcomes than supine positioning?

REVIEW SCOPE
Studies selected compared prone positioning (6 h/d) with supine positioning in adults who had ARDS and were mechanically ventilated. Outcomes were mortality, improvement in oxygenation, days on mechanical ventilation, and ventilator-associated pneumonia.

REVIEW METHODS
PubMed, EMBASE/Excerpta Medica, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials (to Nov 2006); and reference lists were searched for randomised controlled trials (RCTs). Experts were consulted. 5 RCTs (n = 1316) met the selection criteria. All trials had adequate concealment of allocation and minimal or no loss to follow-up.

MAIN RESULTS
Groups did not differ for mortality, although subgroup analysis showed a mortality benefit with prone positioning in more seriously ill patients (table). Oxygenation improved more with prone . . . [Full text of this article]

Nicky Hewitt, RCompN, PGDip(Nursing), Tracey Bucknall

Deakin University, Melbourne, Victoria, Australia