Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis

Abstract

Prone ventilation reduces mortality in patients with severe hypoxemia. Given associated risks, this approach should not be routine in all patients with AHRF, but may be considered for severely hypoxemic patients.

Indications for extracorporeal support: why do we need the results of the EOLIA trial?

“…It must also be emphasized that the most recent studies reported mortality rates for patients with the most severe forms of ARDS, defined as hypoxemia or hypercapnia refractory to initial management and treated conventionally, exceeding 60% [1][2][3]. The results of the first randomized trial were disappointing, but it should be noted that it took place many years ago, when the technology was in its infancy.…”

“…The most severe forms of the disease, of which hypoxemia resulting from pulmonary involvement is the most profound, have an even worse prognosis, with mortality exceeding 60% [2,3], despite recourse to exceptional adjunctive therapies, such as inhaled NO [4], recruitment maneuvers [5], or prone positioning [6].…”

Prone positioning for ARDS: defining the target

“…Severely ill patients, those experiencing improved CO 2 exchange, and those ventilated with large tidal volumes appear more likely to benefit than other members of the general cohort [5]. A superb meta-analysis of pooled data appears in this issue, focusing on those relative few with the worst oxygen exchange [8]. This analysis shows convincingly that, while proning cannot be recommended for all patients with acute lung injury, it does hold therapeutic value for some.…”

“…The novel contribution of the report by Sud et al [8], which included studies regardless of proning duration and timing, is that the meta-analysis pools the collective published experience with patients with uncommonly severe disease and thereby helps define the subpopulation likely to benefit from an inconsistently life-saving intervention. Even severe hypoxemia, however, may itself be too inclusive a category to identify those most amenable to PP.…”

“…The work by Sud et al [8] clearly demonstrates that PP can be life-saving if the patients are well selected and the timing of the intervention is appropriate. How then to best utilize this tool, and in whom?…”