Prone position during mechanical ventilation in critically ill patients
Citation: Bloomfield R, Noble DW, Sudlow A. Prone position for acute respiratory failure in adults. Cochrane Database of Systematic Reviews 2015; (11): CD008095
What is this? Some patients with COVID-19 will become critically ill and develop acute respiratory distress syndrome (ARDS). They may require mechanical ventilation (MV) in an intensive care unit (ICU). They might be placed in the prone position for this, rather than in a supine or recumbent position.
In this Cochrane systematic review, the authors searched for randomized trials of the effects of using a prone position rather than a supine or semi-recumbent position during conventional MV for adults with acute respiratory failure. They did not restrict by language of publication and did their most recent searches in June 2015. They included 9 studies (2165 participants), and identified a further 5 studies that are awaiting classification in a future update of the review.
What works: The studies suggest that patients for whom early implementation of prone positioning or prolonged adoption of prone positioning are used, or who have severe hypoxaemia, are less likely to die.
What doesn’t work: Nothing noted.
What’s uncertain: The groups of patients for whom prone positioning is not beneficial is uncertain.
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