SynthesisIntensive care medicine2014
Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era: a meta-analysis.
Synthesis in Intensive care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04391387 (Clinical Impact of Different Duration Prone Postition Treatment for Patients With ARDS.), which is not on this map. Cited by 81 papers, 9 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.
Clinical Impact of Different Duration Prone Postition Treatment for Patients With ARDS.
Who cites it
81 citing papers in PubMed, 9 syntheses or guidelines pooled it.
- Efficacy and safety of prone position in COVID-19 patients with respiratory failure: a systematic review and meta-analysis.European journal of medical research · 2022Pooled 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
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.Intensive care medicine · 2017Guideline
- Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis.Scientific reports · 2016Pooled it
- 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
- 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
- Early change in ventilatory ratio during prone positioning and 28-day mortality in patients with ARDS: a retrospective cohort study with exploratory eICU assessment.BMC pulmonary medicine · 2026Article
- Management of non-Cardiac Organ Failure in cardiogenic shock.American heart journal plus : cardiology research and practice · 2025Article
- [Prone positioning for acute respiratory distress syndrome in adults : Update on the physiological effects, indications and implementation].Die Anaesthesiologie · 2024Review
- Predictors of in-hospital mortality in elderly unvaccinated patients during SARS-CoV-2 Alpha variants epidemic.Infection prevention in practice · 2024Article
- Prone Positioning in Acute Respiratory Distress Syndrome: Don't Stop Believing...Critical care medicine · 2023Article
- Prone positioning for mechanically ventilated patients with coronavirus disease 2019: the experience of an Irish regional hospital intensive care unit.Irish journal of medical science · 2023Observational
- Treatment options for patients with severe COVID-19.Global health & medicine · 2023Review
- Early Prone versus Supine Positioning in Moderate to Severe Coronavirus Disease 2019 Patients with Acute Respiratory Distress Syndrome.Oman medical journal · 2023Article
- Prone position: how understanding and clinical application of a technique progress with time.Anesthesiology and perioperative science · 2023Review
- Supportive Care in Patients with Critical Coronavirus Disease 2019.Infectious disease clinics of North America · 2022Review
- Mechanical ventilation in COVID-19: A physiological perspective.Experimental physiology · 2022Review
21 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
purposeProne positioning for ARDS has been performed for decades without definitive evidence of clinical benefit. A recent multicenter trial demonstrated for the first time significantly reduced mortality with prone positioning. This meta-analysis was performed to integrate these findings with existing literature and test whether differences in tidal volume explain conflicting results among randomized trials.
methodsStudies were identified using MEDLINE, EMBASE, Cochrane Register of Controlled Trials, LILACS, and citation review. Included were randomized trials evaluating the effect on mortality of prone versus supine positioning during conventional ventilation for ARDS. The primary outcome was risk ratio of death at 60 days meta-analyzed using random effects models. Analysis stratified by high (>8 ml/kg predicted body weight) or low (≤ 8 ml/kg PBW) mean baseline tidal volume was planned a priori.
resultsSeven trials were identified including 2,119 patients, of whom 1,088 received prone positioning. Overall, prone positioning was not significantly associated with the risk ratio of death (RR 0.83; 95% CI 0.68-1.02; p = 0.073; I (2) = 64%). When stratified by high or low tidal volume, prone positioning was associated with a significant decrease in RR of death only among studies with low baseline tidal volume (RR 0.66; 95% CI 0.50-0.86; p = 0.002; I (2) = 25%). Stratification by tidal volume explained over half the between-study heterogeneity observed in the unstratified analysis.
conclusionsProne positioning is associated with significantly reduced mortality from ARDS in the low tidal volume era. Substantial heterogeneity across studies can be explained by differences in tidal volume.
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What OpenQuestion holds
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.