Effectiveness of Prone Positioning versus Supine Positioning in Patients Suffering from Refractory ARDS: A Meta-Analysis

Purpose: Prone positioning (PP) was advocated more than 40 years ago as a means of improving the oxygenation status in patients exhibiting acute respiratory failure (ARF) and acute respiratory distress syndrome (ARDS). The purpose of this meta-analysis is to determine if prone positioning (PP) is a more effective way of treating ARDS patients than supine positioning (SP) in patients that are refractory to conventional mechanical ventilation. Design methods: Relevant electronic databases were searched for studies that met appropriate inclusion criteria. Key Medical Subject Headings (MeSH) terms were utilized such as: ARDS, prone positioning, supine positioning, mortality, and ventilator-associated-pneumonia (VAP). The meta-analysis was performed using Review Manager (RevMan) Version 5.4.1 and Microsoft Excel. Any studies relating to COVID-19 were excluded at this time. Results/Expected results: There was no statistically significant difference between PP and SP in terms of mean intensive care unit (ICU) days. PP showed a statistically significant difference over SP for the secondary outcome of mortality. This study indicated that PP had no statistically significant positive effect on VAP cases. Discussion/conclusions: A glaring limitation of this study is the number of cases as only 4 studies were uncovered that met the criteria for acceptance. Lack of study subjects was another limitation and this can be explained partly by the mindset of practitioners. The use PP is a novel approach to treating ARDS. Practitioner education is vital in expediting the change, with COVID-19 seeming to have become a catalyst. As the amount of research, studies, and education increases, this will allow for creation/modification of policies and procedures that will include PP as a first-line treatment in certain cases.