Effects of prone position on patients with acute respiratory distress syndrome: a systematic review

Abstract

INTRODUCTION: The acute respiratory distress syndrome (ARDS) is characterized by an inflammatory response of the alveolar-capillary membrane to direct or indirect pulmonary injuries with a reduction in to complacency and the presence of pulmonary infiltrates. Such condition causes changes in lung mechanics and gas exchange, causing hypoxemia. OBJECTIVE: To systematically review randomized clinical trials investigating the effects of the disease and its repercussions on oxygenation, respiratory mechanics, mortality and occurrence of adverse events in patients with ARDS. MATERIALS AND METHODS: Systematic review of the literature, following PRISMA recommendations. The searches were performed in the PubMed, BVS, PEDro and SciELO data libraries by two independent reviewers. Included studies randomized clinical trial that presented intervention to positioning therapy in prone, comparing ventilation in prone position with supine. The methodological quality of the studies was evaluated by the PEDro scale. The outcomes analyzed were oxygenation, respiratory mechanics, mortality and occurrence of adverse events, through descriptive analysis. RESULTS: Eight articles were analyzed, with an average of 6 on the PEDro scale. Studies have shown positive oxygenation results, low respiratory mechanics influence influence of respiratory mechanics, improved in mortality rates and high of adverse effects minimized with team training. I highlight the methodological variety and outcomes as a limitation of the research. CONCLUSION: The prone position is capable of promoting beneficial effects in oxygenation, compliance, mortality and reduction of adverse events in individuals with ARDS. However, it is noteworthy the need to perform new clinical trials on the subject, which offer satisfactory samples and similar methodologies.