Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review

Table 2 Meta-analyses on prone position in acute respiratory distress syndrome patients

Meta-analysis	No. of studies included	Total number of patients	Main findings
Sud et al[138]	10	1867	Prone ventilation reduces mortality in patients with severe hypoxemia
Gattinoni et al[136]	4	1573	The individual patient meta-analysis of the four major clinical trials available clearly shows that with prone positioning, the absolute mortality of severely hypoxemic ARDS patients may be reduced by approximately 10%
Lee et al[137]	11	2246	Ventilation in the prone position significantly reduced overall mortality in patients with severe acute respiratory distress syndrome. Sufficient duration of prone positioning was statistically significant in associated with a reduction in overall mortality
Beitler et al[134]	7	2119	Prone positioning was associated with a significant decrease in RR of death only among studies with low baseline tidal volume
Tonelli et al[133]	159	20671	Limited supportive evidence that specific interventions can decrease mortality in ARDS, while low tidal volumes and prone positioning in severe ARDS seem effective
	(93 with overall mortality reported)
	(44 trials reported mortality as a primary outcome)
Park et al[139]	8	2141	Prone positioning tends to reduce the mortality rates in ARDS patients, especially when used in conjunction with a lung protective strategy and longer prone position durations. Prone positioning for ARDS patients should be prioritized over other invasive procedures because related life-threatening complications are rare
Bloomfield et al[140]	9	2165	No convincing evidence of benefit nor harm from universal application of prone positioning in adults with hypoxaemia mechanically ventilated in intensive care units Three subgroups (early implementation of prone positioning, prolonged adoption of prone positioning and severe hypoxaemia at study entry) suggested that prone positioning may confer a statistically significant mortality advantage

ARDS: Acute respiratory distress syndrome.