Does Prone Positioning Decrease Mortality Rate in ARDS? A Systematic Review

Acute Respiratory Distress Syndrome (ARDS) is a clinical condition in which the lungs suffer severe irreversible, large-scale damage causing a grievous form of hypoxemic respiratory failure. Acute respiratory distress syndrome is one of the most evasive diagnosis confronted in the Intensive care unit (ICU) as the name, definition and diagnostic standards have adapted over the past four decades. An ARDS diagnosis is established by physiological criteria and continues to be a diagnosis of exclusion, which makes it crucial that medical professionals expand their knowledge base to effectively diagnose ARDS. Patients admitted with ARDS have high mortality rates ranging from 40 to 60 percent. High-level quality supportive care continues to be the sole option for ARDS treatment. Even with improved supportive care, however, ARDS prognosis is still poor. Extended prone positioning (PP) has been shown to increase alveolar recruitment end expiratory lung volume, thereby improving oxygenation and survival. Unfortunately, few studies have examined the association of mortality and prone positioning in ARDS. A systematic review was conducted to examine the following research question: Does prone positioning compared to supine positioning in patients with ARDS decrease mortality rates? This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Critical Appraisal Skills Programme (CASP). A literature review was performed and data were collected from each study. A cross study analysis was performed and PP was found to reduce mortality rate in patients who were severely hypoxic. The reviewed studies demonstrated that incorporating early and longer periods of PP may improve mortality in ARDS patients, but further research is needed.