Prone Position Ventilation In Acute Respiratory Distress Syndrome: Meta-analysis

Objectives: to systematically assess prone position ventilation (PPV) onthe mortality and the rate of complication in patients with acute lunginjury(ALI) or acute respiratory distress syndrome(ARDS) at the end offlow-up.Methods: collect the randomized controlled trials(RCTs) on PPVtreating ALI/ARDS adult patients extensively. Search the database ofCochrane Library, Pubmed, EMBASE, Web of Science and China BiologyMedicine disc, using the methods of combining MESH subject headingsresearch, free words search and Boolean calculation connective wordstogether. The second research was on the references of included articles.Literature search based on inclusion and exclusion criteria for review andevaluate the quality of the literature. Extract the included studies aboutbaseline data, mortality and incidence of adverse events. Systematic reviewthe included trials by using the software of Cochrane RevMan5.2.6.Theeffect size of Mortality was risk difference(RD) and the effect magnitude ofincidence of adverse events was odds ratio(OR).Results: the number of included literature was five, and a total of1024patients. The effect size of mortality RD is-0.12，95%confidence interval（CI）is [-0.18,-0.06],Z=4.12(P <0.0001).the effect magnitude of incidenceof pneumothorax OR is1.12,95%CI is [0.59,2.11],Z=0.34(P=0.73). Theincidence of Trachea accident OR is1.61,95%CI is [1.03,2.49],Z=2.11(P=0.03).Conclutions: compared with traditional supine position ventilation （SPV），PPV combined with protective ventilation strategies that includedlow tidal volume (VT≤10ml/kg), limiting plateau pressure (end-inspiratoryplateau pressure or peak pressure≤35cmH2O) to treat the early course ofALI/ARDS in adult patients could decrease mortality, but the incidence oftrachea accident increased.