Efficacy of prone ventilation in adult patients with acute respiratory failure: a meta-analysis

Background

The use of prone ventilation in acute respiratory failure has been investigated by several randomised controlled trials in the recent past. To date there has been no systematic review or meta-analysis of these trials.

Objectives

The primary objective was to assess the efficacy of prone ventilation in reducing mortality of adult patients with acute respiratory failure. The secondary objective was to evaluate changes in oxygenation, incidence of pneumonia, duration of mechanical ventilation, ICU and hospital stay, and adverse effects including pressure sores, endotracheal tube or intravascular catheter complications and cost-effectiveness of using prone ventilation.

Methods

A systematic literature search was performed between 1966 and July 2006 to identify randomised controlled trials evaluating prone ventilation.

Measurements and results

Of 229 studies evaluating prone ventilation, five were suitable for inclusion. Prone ventilation was not associated with a reduction in mortality (OR = 0.99; 95% CI = 0.74–1.30), but improvement in oxygenation was significant (mean difference 21.2; P < 0.001). There was no significant difference in the incidence of pneumonia, ICU stay and endotracheal tube complications. There was a trend towards an increased incidence of pressure sores in prone-ventilated patients. The data on duration of mechanical ventilation, intravascular catheter complications or hospital stay were not suitable for meta-analysis. No study reported cost-effectiveness.

Conclusion

The use of prone ventilation is associated with improved oxygenation. It is not associated with a reduction in mortality, pneumonia or ICU stay and may be associated with an increased incidence of pressure sores.