Effects of Prone Positioning on Oxygenation and Complications in Patients With Acute Respiratory Distress Syndrome (ARDS) in the Intensive Care Unit: A Systematic Review and Meta-Analysis.

Background: Acute respiratory distress syndrome (ARDS) is a common disease in the intensive care unit with a high rate of mortality. Prone positioning is an economic and safe treatment for patients with this disease. Prone positioning improves oxygenation, increases end expiratory lung volume, improves imbalances in lung ventilation, and changes the thoracic wall mechanics in ARDS patients. Purpose: This article uses systematic review to examine the effects of prone positioning on oxygenation and complications in ARDS patients. Methods: PubMed, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), eMedline, Chinese Electronic Theses & Dissertations Service (CETD), Chinese Electronic Periodical Services (CEPS), National Digital Library of Theses and Dissertations in Taiwan, and Taiwan Periodical Literature System databasewere searched with predetermined keywords. Nineteen studies, including 9 randomized control trials (RCTs) and 10 non-randomized control trials (non-RCTs) that met the inclusion criteria, were included. Standardized critical appraisal tools from the Joanna Briggs Institute (JBI) were used to assess methodological quality. RevMan 5.1 software was used to conduct the meta-analysis. Results: Prone positioning improved oxygenation, defined as the PaO₂/FiO₂ ratio (mean difference 71.38, 95% Cl [52.74, 90.03], p < .00001). With regard to complications, prone positioning did not influence the incidence of ventilator associated pneumonia (odds ratio [OR] 0.91, 95% Cl [0.45, 1.85], p = .80) or unplanned extubation (OR = 2.31, 95% Cl [0.59, 9.01], p = .23). However, prone positioning did have a significant effect on the incidence of pressure sores (OR = 5.67, 95% Cl [1.24, 25.87], p = .03). Conclusions / Implications for Practice: This review supports the use of prone positioning to improve oxygenation in ARDS patients in clinical practice. Careful implementation by nursing staffs of each prone positioning procedure helps maintain patient safety, improve quality of care, decrease length of hospitalization, and reduce medical costs. [ABSTRACT FROM AUTHOR]