Extended Prone Positioning in ARDS: A Systematic Review and Meta-Analysis.

Area of Science:

• Critical Care Medicine
• Respiratory Medicine
• Evidence Synthesis

Background:

• Prone positioning is a key therapy for moderate-to-severe acute respiratory distress syndrome (ARDS).
• The optimal duration for prone positioning in ARDS patients remains undetermined.
• This study addresses the clinical outcomes of extended versus traditional prone positioning durations.

Purpose of the Study:

• To compare clinical outcomes of extended (≥24 hours) versus traditional (16-24 hours) prone positioning in adults with moderate-to-severe ARDS.
• To evaluate the impact of extended prone positioning on mortality, ventilation duration, and ICU stay.
• To assess adverse events associated with extended prone positioning strategies.

Main Methods:

• Systematic review and meta-analysis of clinical studies.
• Inclusion of studies comparing extended versus traditional prone positioning in mechanically ventilated ARDS patients.
• Analysis of data from 10 studies involving 2,412 subjects, primarily COVID-19-related ARDS.

Main Results:

• Extended prone positioning showed a significant reduction in mortality (RR: 0.76, 95% CI 0.66-0.86).
• No significant differences were observed in the duration of mechanical ventilation or ICU length of stay.
• Increased incidence of pressure injuries was noted with extended prone positioning (RR: 1.30, 95% CI 1.02-1.65), with low to very low certainty of evidence.

Conclusions:

• Extended prone positioning may reduce mortality in ARDS patients.
• The strategy is associated with an increased risk of pressure injuries.
• Further high-quality randomized trials are necessary to validate these findings and guide clinical practice.