SynthesisCritical care (London, England)2011
An updated study-level meta-analysis of randomised controlled trials on proning in ARDS and acute lung injury.
Synthesis in Critical care (London, England), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 11 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
44 citing papers in PubMed, 11 syntheses or guidelines pooled it.
- An appraisal of the methodology and quality of evidence of systematic reviews on the efficacy of prone positional ventilation in adult patients with acute respiratory distress syndrome: an umbrella review.Internal and emergency medicine · 2023Pooled it
- Intubation rate of patients with hypoxia due to COVID-19 treated with awake proning: A meta-analysis.The American journal of emergency medicine · 2021Pooled it
- Guidelines on the management of acute respiratory distress syndrome.BMJ open respiratory research · 2019Guideline
- S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders : Revision 2015: S2e guideline of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI).Der Anaesthesist · 2015Guideline
- Prone position for acute respiratory failure in adults.The Cochrane database of systematic reviews · 2015Pooled it
- [Short version S2e guidelines: "Positioning therapy and early mobilization for prophylaxis or therapy of pulmonary function disorders"].Der Anaesthesist · 2015Guideline
- Extracorporeal life support for acute respiratory failure. A systematic review and metaanalysis.Annals of the American Thoracic Society · 2014Pooled it
- Effects of interventions on survival in acute respiratory distress syndrome: an umbrella review of 159 published randomized trials and 29 meta-analyses.Intensive care medicine · 2014Pooled it
- The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials.Critical care (London, England) · 2014Pooled it
- Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era: a meta-analysis.Intensive care medicine · 2014Pooled it
- Small studies may overestimate the effect sizes in critical care meta-analyses: a meta-epidemiological study.Critical care (London, England) · 2013Pooled it
- Different Duration of Prone Positioning Treatment for Patients with Acute Respiratory Distress Syndrome in Intensive Care Unit Patients: A Prospective Randomized Clinical Study.Journal of clinical medicine · 2025Article
- The impact and relevance of techniques and fluids on lung injury in machine perfusion of lungs.Frontiers in immunology · 2024Review
- Understanding clinical and biological heterogeneity to advance precision medicine in paediatric acute respiratory distress syndrome.The Lancet. Respiratory medicine · 2023Review
- Prone position: how understanding and clinical application of a technique progress with time.Anesthesiology and perioperative science · 2023Review
- Breathing face down.British journal of anaesthesia · 2022Article
- Anaesthesiology as an oasis amid the crisis of the vital medicine 'Oxygen'- innovations and local modifications.Indian journal of anaesthesia · 2021Article
- Multidisciplinary team approach in critically ill COVID-19 patients reduced pronation-related complications rate: A retrospective cohort study.Annals of medicine and surgery (2012) · 2021Article
- Effects of prone positioning during extracorporeal membrane oxygenation for refractory respiratory failure: a systematic review.SN comprehensive clinical medicine · 2021Review
- Prone position in ARDS patients: why, when, how and for whom.Intensive care medicine · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIn patients with acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS), recent randomised controlled trials (RCTs) showed a consistent trend of mortality reduction with prone ventilation. We updated a meta-analysis on this topic.
methodsRCTs that compared ventilation of adult patients with ALI/ARDS in prone versus supine position were included in this study-level meta-analysis. Analysis was made by a random-effects model. The effect size on intensive care unit (ICU) mortality was computed in the overall included studies and in two subgroups of studies: those that included all ALI or hypoxemic patients, and those that restricted inclusion to only ARDS patients. A relationship between studies' effect size and daily prone duration was sought with meta-regression. We also computed the effects of prone positioning on major adverse airway complications.
resultsSeven RCTs (including 1,675 adult patients, of whom 862 were ventilated in the prone position) were included. The four most recent trials included only ARDS patients, and also applied the longest proning durations and used lung-protective ventilation. The effects of prone positioning differed according to the type of study. Overall, prone ventilation did not reduce ICU mortality (odds ratio = 0.91, 95% confidence interval = 0.75 to 1.2; P = 0.39), but it significantly reduced the ICU mortality in the four recent studies that enrolled only patients with ARDS (odds ratio = 0.71; 95% confidence interval = 0.5 to 0.99; P = 0.048; number needed to treat = 11). Meta-regression on all studies disclosed only a trend to explain effect variation by prone duration (P = 0.06). Prone positioning was not associated with a statistical increase in major airway complications.
conclusionsLong duration of ventilation in prone position significantly reduces ICU mortality when only ARDS patients are considered.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.