Ocular Injury Associated With Prone Positioning in Adult Critical Care: A Systematic Review and Meta-Analysis.

Area of Science:

• Critical Care Medicine
• Ophthalmology
• Evidence-Based Medicine

Background:

• Prone positioning is frequently used in critical care to improve oxygenation, especially during the COVID-19 pandemic.
• This positioning strategy is associated with potential adverse events, including ocular injuries.
• Understanding the incidence of eye injuries in prone versus supine positions is crucial for patient safety.

Purpose of the Study:

• To systematically investigate and compare the occurrence of ocular injuries in adult critical care patients placed in prone versus supine positions.
• To conduct a meta-analysis of existing randomized controlled trials to quantify the risk difference.

Main Methods:

• Systematic review and meta-analysis conducted following PRISMA guidelines.
• Searched PubMed, SCOPUS, and Cochrane Library for studies published between January 1, 1990, and July 1, 2020.
• Included eleven randomized controlled trials involving 2,247 adult critical care patients.

Main Results:

• A total of 28 ocular events were reported across 3 trials (174 patients); 8 trials reported no events.
• The overall incidence of eye injury was 1.30% in the prone group and 1.19% in the supine group.
• Meta-analysis revealed no statistically significant difference in ocular injury rates between prone and supine positions (OR 1.40 without edema, OR 0.78 with edema).

Conclusions:

• No significant difference in ocular injury rates was found between prone and supine positioning in critical care.
• Reported ocular injury rates in critical care are higher than those observed during general anesthesia.
• Further research is needed with ocular injury as a primary endpoint and extended patient follow-up in critical care settings.