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Background: At present, there is a preliminary clinical consensus that prone position ventilation (PPV) is beneficial to the treatment of acute respiratory distress syndrome (ARDS), and further research on the details of treatment and patients' benefits will help to assess its effectiveness and safety. Aim: To evaluate the timing, efficacy, and safety of different mechanical ventilation positions (MVP) in treating ARDS. Study Design: The results of clinical trials were directly or indirectly compared by network meta‐analysis to compare the effects of different MVP. Two authors independently searched the papers published in PubMed, Embase, Cochrane Library, China Knowledge Infrastructure (CNKI), China Biomedical Discs (CBM), WanFang, and VIP database from January 2000 to August 2022. The outcome indicators were oxygenation index, mechanical ventilation time, ICU hospitalization time, in‐hospital mortality, and incidence of adverse events. Two authors independently screened the literature, evaluated the quality of the studies, and completed the data extraction. Stata 14.0 was used to conduct a network Meta‐analysis, and the intervention measures were ranked according to the surface under the cumulative ranking curve (SUCRA). Funnel plots were drawn to evaluate publication bias. Results: According to the inclusion and exclusion criteria, 75 studies (including 6333 patient data) were finally included. According to the analysis results, PPV was the best for improving the oxygenation index. The SUCRA values of mechanical ventilation time, ICU hospitalization time, and in‐hospital mortality were ranked as PPV > lateral position ventilation (LPV) > supine position ventilation (SuPV) > semireclining position ventilation (SePV). The SUCRA values in the incidence of adverse events were ranked as LPV > PPV > SuPV > SePV. All outcome measures had good consistency and low statistical heterogeneity. Funnel plot analysis shows that papers reported within three days of mechanical ventilation time, over five days of mechanical ventilation time, and in‐hospital mortality were more likely to have publication bias. Conclusions: PPV has the best effect on improving the oxygenation index, reducing mechanical ventilation time, shortening ICU hospitalization time, and reducing in‐hospital mortality. Early and long‐term use of PPV to improve pulmonary ventilatory function will be the key to improving patients' survival and quality of life with ARDS. Relevance to clinical practice: PPV significantly affects patients with ARDS, which can shorten the treatment time and reduce hospital costs. During the treatment, nursing observation should be strengthened to prevent adverse events. [ABSTRACT FROM AUTHOR]

Background Multisystem inflammatory syndrome in adults (MIS-A) is a severe condition temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods In this retrospective cohort study, we applied the US Centers for Disease Control and Prevention (CDC) case definition to identify diagnosed and undiagnosed MIS-A cases among adults discharged during April 2020–January 2021 from 4 Atlanta, Georgia hospitals affiliated with a single medical center. Non–MIS-A coronavirus disease 2019 (COVID-19) hospitalizations were identified using International Classification of Diseases, Tenth Revision, Clinical Modification encounter code U07.1. We calculated the ratio of MIS-A to COVID-19 hospitalizations, compared demographic characteristics of the 2 cohorts, and described clinical characteristics of MIS-A patients. Results We identified 11 MIS-A cases, none of which were diagnosed by the treatment team, and 5755 COVID-19 hospitalizations (ratio 1:523). Compared with patients with COVID-19, patients with MIS-A were more likely to be younger than 50 years (72.7% vs 26.1%, P <.01) and to be non-Hispanic Black (81.8% vs 50.0%, P =.04). Ten patients with MIS-A (90.9%) had at least 1 underlying medical condition. Two MIS-A patients (18.2%) had a previous episode of laboratory-confirmed COVID-19, occurring 37 and 55 days prior to admission. All MIS-A patients developed left ventricular systolic dysfunction. None had documented mucocutaneous involvement. All required intensive care, all received systemic corticosteroids, 8 (72.7%) required mechanical ventilation, 2 (18.2%) required mechanical cardiovascular circulatory support, and none received intravenous immunoglobulin. Two (18.2%) died or were discharged to hospice. Conclusions MIS-A is a severe but likely underrecognized complication of SARS-CoV-2 infection. Improved recognition of MIS-A is needed to quantify its burden and identify populations at highest risk. [ABSTRACT FROM AUTHOR]

Background Multisystem inflammatory syndrome in children (MIS-C) is a novel severe postinfectious condition associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The purpose of this report is to describe nationwide trends in the evolving clinical management of MIS-C. Methods Patients with MIS-C were reported from state and local jurisdictions to the Centers for Disease Control and Prevention's (CDC's) MIS-C national surveillance system. Patients' case reports were reviewed to ensure that they met the CDC MIS-C case definition and had sufficient data for analysis. The prevalence of use of treatments for MIS-C, temporal trends in use of these treatments, and frequency of administration of different treatment combinations were analyzed. Results There were 4470 patients meeting the MIS-C case definition with onset dates from 19 February 2020 to 31 July 2021. The proportion of patients admitted to an intensive care unit (ICU) has declined over time, from 78.7% in April 2020 to 57.5% in June 2021 (P  = .001). The most common treatments were intravenous immunoglobulin (IVIG), given to 85.6% of patients; steroids (77.7%), and antiplatelet medications (73.7%); use of each of these treatments has increased over time, particularly in patients not requiring admission to an ICU (all P  < .001). Older patients and non-Hispanic Black patients were more likely to receive additional modes of therapy including vasoactive medication, noninvasive respiratory support, anticoagulation medication, and intubation/mechanical ventilation. Conclusions IVIG, steroids, and antiplatelet medication have become increasingly utilized as standard treatment for MIS-C patients, while the use of other treatments may be contingent on the type and severity of clinical findings. [ABSTRACT FROM AUTHOR]