Efficacy of prone position in acute respiratory distress syndrome: overview of systematic reviews

Abstract

Objective:To identify and integrate the available scientific evidence related to the use of the prone position in patients with acute respiratory distress syndrome for the reduction of the outcome variable of mortality compared to the dorsal decubitus position. Method: Overview of systematic reviews or meta-analyzes of randomized clinical trials. It included studies that evaluated the use of prone positioning in patients with acute respiratory distress syndrome published between 2014 and 2016. The AMSTAR tool was used to determine the methodological quality of studies. The GRADE system was used to establish the overall quality of evidence for the mortality outcome. Results: From the search strategy, were retrieved seven relevant manuscripts of high methodological quality. Conclusion: Scientific evidence supports that combined use of protective ventilatory strategy and prone positioning for periods between 16 and 20 hours in patients with acute respiratory distress syndrome and PaO2/FiO2 ratio lower than 150 mm/Hg results in significant reduction of mortality rate. DESCRIPTORSCritical Care; Prone Position; Respiratory Distress Syndrome, Adult; Evidence-Based Nursing; Evidence-Based Practice; Review.Efficacy of prone position in acute respiratory distress syndrome: overview of systematic reviews Efetividade da posição prona na síndrome do desconforto respiratório agudo: overview de revisões sistemáticas Efectividad de la posición prona en el síndrome de dificultad respiratoria aguda: overview de revisiones sistemáticas Efficacy of prone position in acute respiratory distress syndrome: overview of systematic reviewsRev Esc Enferm USP · 2017;51:e03251 INTRODUCTIONAcute Respiratory Distress Syndrome (ARDS) is a potentially devastating form of hypoxemic respiratory failure caused by acute inflammatory lung injury (1) . Its characteristics are the sudden onset, presence of a triggering factor (diffuse bilateral pulmonary infiltrate), and normally there is no left heart failure (non-cardiogenic pulmonary edema) or circulatory overload (2) . In 2012, was proposed a new model for the standardization of diagnostic concepts of acute respiratory distress syndrome that took into account the severity of the disease (ARDS Definition Task Force). The name of the recommendation is Berlin Definition, and patients with ARDS are stratified into three categories, namely: mild ( . ARDS is a high incidence phenomenon in the field of intensive care. In this regard, 29,144 patients admitted to intensive care units were evaluated in a multicenter, international and prospective cohort study. It was found that 3,022 patients (10.4%) met the clinical criteria for ARDS. Of these, 2,377 patients developed the disease within the first 48 hours and required invasive ventilatory support to suppress severe acute respiratory failure. The mortality rate was directly proportional to the severity of disease, as follows: 35% among patients with mild ARDS, 40% among patients with moderate ARDS, and 46% for patients with severe ARDS. Incidence r...

Prone Ventilation for Severe Ards in a Perioperative Caesarean Patient

“…Driving pressure is the main variable determining the best prognosis for the mortality outcome in patients with moderate or severe ARDS. [19] Thus, the available scientific evidence suggests that early combination of using protective ventilatory strategy with a sustained driving pressure of less than 16 cm H2O and prone positioning for periods of 16 to 20 hours in patients with severe acute respiratory distress syndrome results in benefits on mortality reduction [20] and postoperative status should not deter intensivists from proning a patient with severe ARDS.…”

Factors Influencing Prone Positioning in Treating Acute Respiratory Distress Syndrome and the Effect on Mortality Rate

“…More than 75% of patients require mechanical ventilation during their ICU stay, resulting in fatality for 33% to 37% of mechanically ventilated patients [1]. Acute respiratory distress syndrome (ARDS) is a form of hypoxemic respiratory failure resulting from acute inflammatory lung injury [2]. Patients treated for ARDS typically have prolonged hospitalizations with resultant increased hospital costs and overall greater consumption of resources [2,3].…”

“…Acute respiratory distress syndrome (ARDS) is a form of hypoxemic respiratory failure resulting from acute inflammatory lung injury [2]. Patients treated for ARDS typically have prolonged hospitalizations with resultant increased hospital costs and overall greater consumption of resources [2,3]. Those patients who survive are often burdened with disabilities such as muscle weakness and neuropsychiatric problems for months and even for years after being discharged from the hospital [4].…”

“…While prone positioning is mentioned in the literature as beneficial for the reasons noted above, several studies have reviewed the variables that can affect recovery and mortality. Such variables that have been investigated are the timing of treatment, duration of time a patient was in the prone position, tidal volume relative to body weight, and severity of ARDS [2,5,[9][10][11]. This narrative review aims to review the effect of prone positioning in patients with ARDS on mortality rate.…”

Avaliação Do Perfil Dos Pacientes Com Síndrome Da Apneia Obstrutiva Do Sono E Outras Comorbidades Em Um Serviço De Fisioterapia

“…A síndrome do desconforto respiratório agudo (SARA) é uma forma potencialmente agressiva de insuficiência respiratória hipoxêmica, ocasionada por lesão pulmonar inflamatória aguda, e caracterizada por um quadro de instalação súbita, presença de um fator desencadeante, infiltrado pulmonar bilateral difuso e, normalmente, ausência de insuficiência cardíaca esquerda ou de sobrecarga do sistema circulatório. (DALMEDICO et al, 2017) A síndrome respiratória apresenta uma taxa de mortalidade e morbidade relativamente alta, considerando as evoluções tecnológicas surgidas nas últimas décadas. Uma das terapêuticas recomendada para seu tratamento é a utilização da posição prona, que vem sendo estudada desde 1974 e tem ganhado relevância por melhorar a hipoxemia em 70% dos casos.…”