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Báo cáo y học: "An updated study-level meta-analysis of randomised controlled trials on proning in ARDS and acute lung injury"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: An updated study-level meta-analysis of randomised controlled trials on proning in ARDS and acute lung injury. | Abroug et al. Critical Care 2011 15 R6 http ccforum.eom content 15 1 R6 KS CRITICAL CARE RESEARCH Open Access An updated study-level meta-analysis of randomised controlled trials on proning in ARDS and acute lung injury 1 1 1 1 2.3.4 Fekri Abroug Lamia Ouanes-Besbes Fahmi Dachraoui Islem Ouanes Laurent Brochard Abstract Introduction In 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. Methods RCTs 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. Results Seven 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 . Metaregression on all studies disclosed only a trend to explain effect variation by prone duration P 0.06 . Prone positioning was not associated with a .