In patients with severe ARDS in the critical care setting, does the prone position, compared with the non-prone position, improve oxygenation and reduce mortality rate and mechanical ventilation duration?

Abstract

Abstract Background: Prone position can be beneficial on patients with acute respiratory distress syndrome (ARDS). The findings from the reviewed studies vary, and the benefits of prone positioning in reducing mortality of patients with ARDS are still controversial. Additional studies are required to assess the effect of prone positioning on oxygenation, duration on mechanical ventilation, and the mortality rate of patients with ARDS. Objective: The purpose of this systematic literature review was to assess the efficacy of prone positioning in increasing oxygenation, reducing the mechanical ventilation duration, and reducing mortality rates in patients with ARDS. Methods: This systematic review involved searching through the electronic databases of Embase, CINAHL, and Medline to identify relevant studies. Seven randomised controlled trials (RCTs) involving adult patients with ARDS were selected for the review. The Critical Appraisal Skills Programme tool was utilised to determine the quality of the eligible studies. Findings: Seven studies that were related to the research topic and met the inclusion criteria were included in the literature review. This dissertation was based on RCTs. The survival rate following severe ARDS was considerably higher in the group receiving prone position than in the supine group. The prone positioning duration and the interval between the beginning of ARDS and the time the prone position was applied are significant determinants of its effectiveness. Prone positioning enhanced oxygenation in over 70% of the cases where it was applied, with approximately 70% of the impact taking place during the initial application hour. Prone positioning also reduced the mechanical ventilation duration in the patients with ARDS. This dissertation was based on RCTs and three databases were used for the retrieval of the relevant articles. A quantitative research method was used and the inclusion and exclusion criteria were accurately selected to optimize the internal and external validity of the review. Critical appraisal of the eligible studies made it easy to focus on studies relevant to the research question. However, these studies had several limitations, which must be considered when reviewing their findings. Conclusion: Prone positioning has beneficial effects on improving oxygenation and reducing the days on mechanical ventilation in patients with ARDS in the ICU. However, based on the reviewed studies, the outcome of prone positioning on mortality of patients with ARDS remains unclear. Further large scale RCTs are necessary to provide clarity on the effect of prone position vs. supine position on mortality of patients with ARDS.