Mortality in mechanical ventilation in prone position in patients with acute respiratory distress síndrome

Abstract

Introduction: Prone ventilation has been shown to improve oxygenation and lung mechanics in patients with acute respiratory distress syndrome, but I consider it necessary to delve deeper into the relationship between the prone position and mortality. Objectives: To evaluate whether the prone position decreases the risk of mortality in adult patients with acute respiratory distress syndrome vs. supine ventilation, in a global and segmented manner, as well as to know the main adverse effects related to it. Material and methods: A meta-analysis of randomized controlled clinical trials comparing patients in the prone vs. supine position was performed with a search in Pubmed, Embase, Cochrane Library and LILACS, and mortality, hospital stay, days of mechanical ventilation and adverse effects were evaluated. Results: Seven randomized controlled clinical trials were included in the analysis. The prone position showed a non-significant tendency to decrease mortality when analyzed globally. When stratified by subgroups, a significant decrease in the risk of mortality was found in patients: 1) ventilated with low tidal volume, 2) prolonged prone position, and 3) established before 48 hours of disease progression in severe hypoxemia. The adverse effects related to prone position were the development of pressure ulcers and orotracheal tube obstruction.
 Conclusion: Prone position ventilation is a safe strategy and reduces mortality in patients with severe oxygenation impairment. It should be established early, for prolonged periods, and associated with a protective ventilation strategy.